Evidence map›Paper›PMID 41552757›Full record

ArticleResearch and practice in thrombosis and haemostasis2026

Safety and efficacy of direct oral anticoagulants in patients with liver cirrhosis: a meta-analysis.

Daniel Tham, Wenhui Yu, Lucy Zhao, Roger Kou, Jayhan Kherani, Pei Yi Li, Shreyas Sreeraman, Ali Eshaghpour, Allen Li, Mark A Crowther

Abstract read
In one paragraph

Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Direct oral anticoagulants in patients with advanced cirrhosis: is it time?Research and practice in thrombosis and haemostasis · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniel ThamFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Wenhui YuFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Lucy ZhaoTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Roger KouFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Jayhan KheraniTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Pei Yi LiTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Shreyas SreeramanSchulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Ali EshaghpourDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
Allen LiDivision of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Mark A CrowtherDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Direct oral anticoagulants (DOACs) are the standard of care for treatment of venous thromboembolism and stroke prophylaxis in atrial fibrillation. Since patients with Child-Pugh (CP) B or C liver cirrhosis are underrepresented in trials, the safety of DOACs in this population is unclear. Objectives: This study synthesized primary evidence on the safety profile of DOACs in patients with advanced liver cirrhosis. Methods: A literature search of MEDLINE and Embase from inception to October 2025 identified randomized and nonrandomized cohort studies comparing DOAC with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis. Screening and data collection were conducted in duplicate. The primary outcome was major bleeding defined by International Society on Thrombosis and Haemostasis criteria, stratified by CP class. Data were meta-analyzed using a random-effects model, presented as odds ratios (OR) with corresponding 95% CIs. Results: Of 797 articles captured in the literature search, 15 nonrandomized ( Conclusion: Based on the findings of this meta-analysis, DOACs may be associated with a reduced risk of major bleeding compared with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis, including those with CP class B and C cirrhosis. The results of this meta-analysis should be interpreted in the context of methodological limitations. Future analysis should evaluate the impact of specific DOACs and dosage on safety outcomes in this patient population.

Indexed as

factor Xa inhibitorshemorrhageliver cirrhosisvenous thromboembolismwarfarin

Identifiers

PMID41552757
PMCPMC12804106

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.