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direct oral anticoagulants for the treatment of splanchnic vein thrombosis:A state of art

World Journal of Gastroenterology 2023年第33期29卷 4962-4974页

作者： Giovanni Monaco Luca Bucherini Bernardo Stefanini Fabio Piscaglia Francesco Giuseppe Foschi Luca Ielasi Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy Division of Internal Medicine Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy Department of Internal Medicine Ospedale degli Infermi di FaenzaFaenza 48018Italy

Splanchnic vein thrombosis(SVT)is a manifestation of venous thromboembolism in an unusual ***,mesenteric,and splenic veins are the most common vessels involved in SVT which occurs mainly in patients with liver cirrhosis,although non-cirrhotic patients could be affected as *** of hepatic veins,also known as Budd-Chiari syndrome,is another manifestation of *** diagnosis and intervention are mandatory in order to increase the recalization rate and reduce the risk of thrombus progression and hypertensive *** anticoagulation with heparin and vitamin-K antagonists is the treatment of choice in these ***,recent studies have shown promising results on the efficacy and safety of direct oral anticoagulants(DOACs)in this *** results are mainly based on retrospective studies with small sample size,but first clinical trials have been published in the last *** manuscript aims to provide an updated overview of the current evidence regarding the role of DOACs for SVT in both cirrhotic and non-cirrhotic patients.

关键词： Splanchnic vein thrombosis Portal vein thrombosis Budd-Chiari syndrome direct oral anticoagulants

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Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants

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World Journal of Gastroenterology 2023年第19期29卷 2916-2931页

作者： Mitsushige Sugimoto Masaki Murata Takashi Kawai Department of Gastroenterological Endoscopy Tokyo Medical University HospitalTokyo 160-0023Japan Department of Gastroenterology National Hospital Organization Kyoto Medical CenterKyoto 612-8555Japan

Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal *** rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD *** fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving ***,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical *** that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.

关键词： direct oral anticoagulants Gastrointestinal tumors Endoscopic submucosal dissection Delayed bleeding Adverse events anticoagulants

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Anupdated pooled analysis of off-label under-and over-dosed direct oral anticoagulants in patients with atrial fibrillation Effectiveness and safety of DOACs off-label doses in AF

Anupdated pooled analysis of off-label under-and over-dosed ...

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2023年浙江省医药学学术年会

作者：沈男男王佳良绍兴文理学院附属医院

Introduction:Off-label under-and overdosed direct oral anticoagulants(DOACs) are commonly prescribed to patients with atrial fibrillation(AF),but real-world evidence on their effectiveness and safety is ***:MEDLINE,Embase,and Cochrane Library databases were systematically searched from 01 July 2020 to 28 February 2022,updating the previous systematic review with the same search strategy,that started from inception to 30 June 2020,for studies reporting effectiveness(ischemic stroke/systemic embolism and myocardial infarction) or safety(gastrointestinal or major bleeding,and death) outcomes of off-label doses of DOACs compared with on-label doses in AF patients.A random-effects meta-analysis was performed to estimate the pooled hazard ratio and 95% confidence intervals(CI).Subgroup analyses by specific DOACs and different geographic regions were also ***:Twenty-two studies reporting real world evidence on 223,057 patients were ***-label underdosed DOACs compared to on-label dose were not associated with any increased risk of stroke(HR 1.03,95%CI:0.88-1.17),but were associated with an increased risk of death(HR 1.26,95%CI:1.09-1.43),although risks varied based on the active *** other safety outcomes were associated withunderdosed *** significant differences could be observed by geographic region of *** to on-label DOACs,over-dosing increased the risk ofstroke(HR 1.17,95%CI:1.04-1.31),major bleeding(HR1.18,95%CI:1.05-1.31) and death(HR 1.19,95%CI:1.03-1.35).Risks varied across different geographic ***:Offlabel underdosed compared to on-label DOACs did not increase the risk of stroke,but they increased overall ***-dosed compared to on-label DOACs were associated with an increased risk of stroke,major bleeding,and *** studies are required to further examine this association,with greater attention to specific active ingredients and geographic settings.

关键词： atrial fibrillation direct oral anticoagulants off-label stroke bleeding

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