Liver injury from direct oral anticoagulants.
Liver injury from direct oral anticoagulants.
复制标题
DOI：
10.4254/wjh.v15.i6.841
复制
发表时间：
2023-06-27
影响因子：
2.4
通讯作者：
Jain R
中科院分区：
文献类型：
--
作者：
Juneja D;Nasa P;Jain R
药物性肝损伤（DILI）可由任何处方药物引起，是撤回新上市药物的重要原因。直接作用口服抗凝剂（DOAC）是最近引入的非维生素K拮抗剂，越来越多地用于各种临床条件。对29项随机对照试验和152116例患者进行的荟萃分析报告，DOAC未增加DILI风险。然而，在从这些研究中排除既存肝病患者的情况下，预测个体患者中DILI的风险因素具有挑战性。通过对近期病例报告和系列的系统性综述和荟萃总结，确定继发于DOAC的DILI患者的风险因素和结局。对多个数据库（包括PubMed、Science Direct、Reference Citation Analysis和Google Scholar）进行了系统检索。检索词包括“急性肝衰竭”或“慢性肝衰竭急性发作”或“急性化学品和药物诱导的肝损伤”或“慢性化学品和药物诱导的肝损伤”和“Xa因子抑制剂”或“达比加群”或“利伐沙班”或“阿哌沙班”或“贝曲沙班”或“依度沙班”或“奥他沙班”。对以英语发表的成人患者文献的结果进行过滤。仅纳入了报告继发于DOAC的DILI病例的病例报告和病例研究。提取了人口统计学、合并症、用药史、实验室检查、影像学、组织学、管理和结局的数据。共15项研究（13份病例报告和2个病例系列）被纳入分析，包括27例继发于DOAC的DILI患者。利伐沙班是最常见的DOAC（n = 20，74.1%）。至发生DILI的平均时间为40.6 d。最常见的症状为黄疸（n = 15，55.6%）、不适（n = 9，33.3%）和呕吐（n = 9，33.3%）。实验室检查显示肝酶和胆红素水平升高。影像学检查和肝活检显示急性肝炎和胆汁淤积性损伤的特点。大多数患者结局良好，仅1例患者（3.7%）死于肝功能衰竭。DOAC越来越多地用于各种临床疾病，继发于DOAC的DILI是一种罕见但可能严重的并发症。及时识别和停用违规药物对于DILI的管理至关重要。大多数继发于DOAC的DILI患者结局良好，但小部分患者可能进展为肝衰竭和死亡。需要进一步研究，包括上市后基于人群的研究，以更好地了解继发于DOAC的DILI的发生率和风险因素。
Drug-induced liver injury (DILI) can be caused by any prescribed drug and is a significant reason for the withdrawal of newly launched drugs. Direct-acting oral anticoagulants (DOACs) are non-vitamin K-based antagonists recently introduced and increasingly used for various clinical conditions. A meta-analysis of 29 randomised controlled trials and 152116 patients reported no increased risk of DILI with DOACs. However, it is challenging to predict the risk factors for DILI in individual patients with exclusion of patients with pre-existing liver disease from these studies. To determine the risk factors and outcomes of patients who developed DILI secondary to DOACs by systematic review and meta-summary of recent case reports and series. A systematic search was conducted on multiple databases including PubMed, Science Direct, Reference Citation Analysis, and Google Scholar. The search terms included “Acute Liver Failure” OR “Acute-On-Chronic Liver Failure” OR “Acute Chemical and Drug Induced Liver Injury” OR “Chronic Chemical and Drug Induced Liver Injury” AND “Factor Xa Inhibitors” OR “Dabigatran” OR “Rivaroxaban” OR “apixaban” OR “betrixaban” OR “edoxaban” OR “Otamixaban”. The results were filtered for literature published in English and on adult patients. Only case reports and case studies reporting cases of DILI secondary to DOACs were included. Data on demographics, comorbidities, medication history, laboratory investigations, imaging, histology, management, and outcomes were extracted. A total of 15 studies (13 case reports and 2 case series) were included in the analysis, comprising 27 patients who developed DILI secondary to DOACs. Rivaroxaban was the most commonly implicated DOAC (n = 20, 74.1%). The mean time to onset of DILI was 40.6 d. The most common symptoms were jaundice (n = 15, 55.6%), malaise (n = 9, 33.3%), and vomiting (n = 9, 33.3%). Laboratory investigations showed elevated liver enzymes and bilirubin levels. Imaging studies and liver biopsies revealed features of acute hepatitis and cholestatic injury. Most patients had a favourable outcome, and only 1 patient (3.7%) died due to liver failure. DOACs are increasingly used for various clinical conditions, and DILI secondary to DOACs is a rare but potentially serious complication. Prompt identification and cessation of the offending drug are crucial for the management of DILI. Most patients with DILI secondary to DOACs have a favourable outcome, but a small proportion may progress to liver failure and death. Further research, including post-marketing population-based studies, is needed to better understand the incidence and risk factors for DILI secondary to DOACs.
登录
查看更多内容
影响因子：
6.6
作者：
Devarbhavi, Harshad;Aithal, Guruprasad;Sarin, Shiv K.
通讯作者：
Sarin, Shiv K.
影响因子：
29.4
作者：
Goldberg DS;Forde KA;Carbonari DM;Lewis JD;Leidl KB;Reddy KR;Haynes K;Roy J;Sha D;Marks AR;Schneider JL;Strom BL;Corley DA;Lo Re V 3rd
通讯作者：
Lo Re V 3rd
影响因子：
0.9
作者：
Clarke, Sherri-Anne;Alsaad, Ali A;Phillips, Michael B
通讯作者：
Phillips, Michael B
影响因子：
29.4
作者：
Nicoletti P;Aithal GP;Bjornsson ES;Andrade RJ;Sawle A;Arrese M;Barnhart HX;Bondon-Guitton E;Hayashi PH;Bessone F;Carvajal A;Cascorbi I;Cirulli ET;Chalasani N;Conforti A;Coulthard SA;Daly MJ;Day CP;Dillon JF;Fontana RJ;Grove JI;Hallberg P;Hernández N;Ibáñez L;Kullak-Ublick GA;Laitinen T;Larrey D;Lucena MI;Maitland-van der Zee AH;Martin JH;Molokhia M;Pirmohamed M;Powell EE;Qin S;Serrano J;Stephens C;Stolz A;Wadelius M;Watkins PB;Floratos A;Shen Y;Nelson MR;Urban TJ;Daly AK;International Drug-Induced Liver Injury Consortium, Drug-Induced Liver Injury Network Investigators, and International Serious Adverse Events Consortium
通讯作者：
International Drug-Induced Liver Injury Consortium, Drug-Induced Liver Injury Network Investigators, and International Serious Adverse Events Consortium
影响因子：
--
作者：
Keisu, M;Andersson, T B
通讯作者：
Andersson, T B