ArticlePloS one2014
Differential in vitro inhibition of thrombin generation by anticoagulant drugs in plasma from patients with cirrhosis.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed, 97 citations in OpenAlex.
- Direct oral anticoagulants in patients with advanced cirrhosis: is it time?Research and practice in thrombosis and haemostasis · 2026Article
- Prediction and prevention of post-procedural bleedings in patients with cirrhosis.Clinical and molecular hepatology · 2025Review
- Direct oral anticoagulants in cirrhosis: Rationale and current evidence.JHEP reports : innovation in hepatology · 2024Review
- Direct oral anticoagulants to treat deep venous thrombosis and pulmonary embolism in patients with cirrhosis: are we there yet?Hematology. American Society of Hematology. Education Program · 2023Article
- Patients with metabolic dysfunction-associated steatotic liver disease have preservedResearch and practice in thrombosis and haemostasis · 2023Article
- Portal Vein Thrombosis in the Setting of Cirrhosis: A Comprehensive Review.Journal of clinical medicine · 2022Review
- Pathophysiology and management of bleeding and thrombosis in patients with liver disease.International journal of laboratory hematology · 2022Review
- Heparins have adequate ex vivo anticoagulant effects in hospitalized patients with cirrhosis.Journal of thrombosis and haemostasis : JTH · 2021Article
- Targeting von Willebrand factor in liver diseases: A novel therapeutic strategy?Journal of thrombosis and haemostasis : JTH · 2021Review
- Differentiating biochemical from clinical heparin resistance in COVID-19.Journal of thrombosis and thrombolysis · 2020Article
- Efficacy of pro- and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery.Journal of thrombosis and haemostasis : JTH · 2020Article
- Implications of direct oral anticoagulation and antiplatelet therapy in intensive care.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2020Article
- Recurrent Left Ventricular Thrombus Formation on Rivaroxaban Therapy in Cardiomyopathy and Liver Cirrhosis.JACC. Case reports · 2020Article
- Effectiveness of venous thromboembolism prophylaxis in patients with liver disease.World journal of hepatology · 2019Article
- Ten things ICU specialists need to know about direct oral anticoagulants (DOACs).Intensive care medicine · 2019Article
- Direct Oral Anticoagulants in Cirrhotic Patients: Current Evidence and Clinical Observations.Canadian journal of gastroenterology & hepatology · 2019Review
- Hypercoagulability in End-stage Liver Disease: Review of Epidemiology, Etiology, and Management.Transplantation direct · 2018Article
- In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2018Article
- Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference.Thrombosis and haemostasis · 2018Article
- Role of the blood coagulation cascade in hepatic fibrosis.American journal of physiology. Gastrointestinal and liver physiology · 2018Review
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTreatment and prevention of thrombotic complications is frequently required in patients with cirrhosis. However anticoagulant therapy is often withheld from these patients, because of the perceived bleeding diathesis. As a result of the limited clinical experience, the anticoagulant of choice for the various indications is still not known.
objectivesWe evaluated the in vitro effect of clinically approved anticoagulant drugs in plasma from patients with cirrhosis. PATIENTS/
methodsThirty patients with cirrhosis and thirty healthy controls were studied. Thrombin generation assays were performed before and after addition of unfractionated heparin, low molecular weight heparin, fondaparinux, dabigatran, and rivaroxaban, to estimate anticoagulant potencies of these drugs.
resultsAddition of dabigatran led to a much more pronounced reduction in endogenous thrombin potential in patients compared to controls (72.6% reduction in patients vs. 12.8% reduction in controls, P<0.0001). The enhanced effect of dabigatran was proportional to the severity of disease. In contrast, only a slightly increased anticoagulant response to heparin and low molecular weight heparin and even a reduced response to fondaparinux and rivaroxaban was observed in plasma from cirrhotic patients as compared to control plasma.
conclusionsThe anticoagulant potency of clinically approved drugs differs substantially between patients with cirrhosis and healthy individuals. Whereas dabigatran and, to a lesser extent, heparin and low molecular weight heparin are more potent in plasma from patients with cirrhosis, fondaparinux and rivaroxaban showed a decreased anticoagulant effect. These results may imply that in addition to dose adjustments based on altered pharmacokinetics, drug-specific dose adjustments based on altered anticoagulant potency may be required in patients with cirrhosis.
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