ArticleResearch and practice in thrombosis and haemostasis2023
Clinically relevant increases in the international normalized ratio and model of end-stage liver disease score by therapeutic doses of direct oral anticoagulants in patients with cirrhosis.
Article in Research and practice in thrombosis and haemostasis, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Activated charcoal neutralization restores accurate Model for End-Stage Liver Disease and Child-Pugh scores in patients with cirrhosis on direct oral anticoagulant therapy.Research and practice in thrombosis and haemostasis · 2026Article
- Update in the treatment of cirrhotic patients with portal vein thrombosis.Clinical and molecular hepatology · 2025Review
- Direct oral anticoagulants in cirrhosis: Rationale and current evidence.JHEP reports : innovation in hepatology · 2024Review
- Response to "Clinically relevant increases in the international normalized ratio and model of end-stage liver disease score by therapeutic doses of direct oral anticoagulants in patients with cirrhosis".Research and practice in thrombosis and haemostasis · 2023Article
- Hematohepatology: The potential for direct oral anticoagulant "Inflation" in liver transplant candidates.Research and practice in thrombosis and haemostasis · 2023Article
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Authors and funding
6 authors.
Funding
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Abstract
Background: Patients with cirrhosis are increasingly using direct oral anticoagulants (DOACs) in therapeutic doses for the treatment of portal vein thrombosis or for concomitant atrial fibrillation. DOACs may affect routine diagnostic tests of coagulation including the international normalized ratio (INR). The INR is a part of the model of end-stage liver disease (MELD) score, a validated score that predicts the mortality risk in patients with cirrhosis and is used to prioritize patients for liver transplantation. DOAC-induced increases in the INR may thus lead to artificial inflation of the MELD score. Objective: We studied the effect of DOACs on INR prolongation in patients with cirrhosis. Methods: We spiked plasma from 20 healthy individuals and 20 patients at the start of liver transplantation with DOACs in concentrations representing peak therapeutic levels. In addition, we studied INR increases in healthy controls and patients with mild cirrhosis who received the DOAC edoxaban for 1 week for study purposes. Results: In controls and patients, the INR increased by an Conclusions: Taken together, DOACs result in an INR increase that translates to clinically meaningful increases in MELD points in patients with cirrhosis, and precautions to avoid artificial inflation of the MELD score in these patients are warranted.
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