Use of Newer Anticoagulants in Patients with Cirrhosis

Purpose of Review: This review addresses common clinical scenarios which may require anticoagulation in liver disease patients, the safety and efficacy of direct acting oral anticoagulation (DOAC) agents in liver disease, DOAC dosing considerations based on hepatic or renal impairment, and when anticoagulation should possibly be held or reversed. Recent Findings: The use of DOACs is considered safe and effective compared to traditional therapies like vitamin K antagonists (VKAs) and heparin in patients with liver disease although there is likely an increased risk of bleeding in patients with Child–Pugh B and C. Summary: In the setting of liver disease, anticoagulation with DOAC therapy is considered safe and effective. However, there is likely an increased risk of bleeding in Child-Pugh B and C but further studies are needed to quantify this risk. There is no guidance at this time on DOAC-level monitoring, but future studies evaluating its use may be helpful in liver disease patients. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.