- Email: [email protected]
or cirrhosis
ORAL PRESENTATIONS O077 USE OF DIRECT ORAL ANTICOAGULANTS (DOACS) IN PATIENTS WITH SPLANCHNIC VEIN THROMBOSIS AND/OR CIRRHOSIS A. De Gottardi1 , S. Seijo2 , A. Plessier3 , J. Schouten4 , J. Trebicka5 , B. Terziroli6 , L. Magenta6 , D. Semela7 , P. Langlet8 , F. Turon9 , R. Arya2 , M. Peck-Radosavljevic10 , D. Valla3 , J.C. Garcia-Pagan9 , EASL-VALDIG Consortium. 1 Hepatology, Inselspital, Berne, Switzerland; 2 Hepatology, King’s College, London, United Kingdom; 3 Hepatology, Hˆ opital Beaujon, Paris, France; 4 Gastroenterology, AZ Nikolaas, St. Nikolaas, Belgium; 5 Gastroenterologie, University of Bonn, Bonn, Germany; 6 Epatocentro, Lugano, 7 Gastroenterology, Kantonsspital, St. Gallen, Switzerland; 8 CHIREC, Brussels, Belgium; 9 Liver Unit, Hospital Clinic, Barcelona, Spain; 10 Hepatology, Medical University, Vienna, Austria E-mail: [email protected] Background and Aims: DOACs are increasingly used off label in patients with splanchnic vein thrombosis and/or cirrhosis. Since efficacy and safety remain a concern in these patients, our aim was to describe the indications of DOACs, the reasons for switching from other anticoagulants and the possible adverse effects. Methods: A questionnaire including demographic information, laboratory data, DOACs treatment characteristics and complications was sent to the members of the VALDIG Consortium from 42 centers in 15 countries. Results: Thirty-three centers (79%) answered the questionnaire. The use of DOACs in patients with splanchnic vein thrombosis (SVT) and/or cirrhosis was reported for 35 cases (8 centers in 6 European countries). Patients (21 men/14 women) were aged 52 (range 16–82 years). Indications for anticoagulation were SVT (22), peripheral deep vein thrombosis (1), Budd-Chiari syndrome (3), atrial fibrillation (5) and others (4). The DOACs used were rivaroxaban (31), dabigatran (3) and apixaban (1) for a median of 7 months (range 1–42). The reasons for choosing DOACs were no need for INR monitoring (17), to avoid injections (4), previous complications of other anticoagulants (7) and unknown (7). There were 13 patients with cirrhosis and median Child–Pugh score B7 (range 6–9), MELD 8 (range 7–13). In cirrhotic patients the median daily dose of rivaroxaban was 15 mg (n = 11), of apixaban 10 mg (n = 1) and of dabigatran 220 mg (n = 1). During treatment, creatinin, bilirubin, albumin, platelet counts and ALT did not change significantly, while INR increased from 1.72 to 2.19 (p = 0.002). Adverse events included 1 case of anemia probably due to portal hypertensive gastropathy, 1 case of dizziness and disorientation and 1 case of progression of SVT. In 1 patient rivaroxaban was stopped due to hepato-renal syndrome. Conclusions: A limited number of patients with SVT and/or cirrhosis are currently treated with DOACs. The most frequent reason for choosing DOACs is no need for INR monitoring. DOACs seem to be safe because no major bleeding episodes or liver deterioration occurred during treatment, but there is a compelling need for more data in this field.
O078 THE PREVALENCE AND MORTALITY OF ACUTE-ON-CHRONIC LIVER FAILURE DEFINED BY APASL VS. EASL–CLIF CONSORTIUM: A MULTICENTER, RETROSPECTIVE COHORT STUDY IN KOREA (KACLIF STUDY) D.S. Song1 , T.Y. Kim2 , D.J. Kim3 , H.Y. Kim1 , D.H. Shinn4 , E.L. Yoon5 , J.H. Sohn2 , C.W. Kim1 , Y.K. Jung6 , K.T. Suk3 , J.M. Yang1 , H.J. Lee7 . 1 Internal medicine, College of Medicine, The Catholic University College of Korea, Seoul, 2 Internal medicine, Hanyang University Guri Hospital, Guri, 3 Internal medicine, Hallym University, Chunchon Sacred Heart Hospital, Chunchon, 4 Internal medicine, Samsung Medical Center, 5 Internal medicine, Inje University Sanggye Paik Hospital, Seoul, 6 Internal medicine, Korea University Ansan Hospital, Ansan, 7 Internal medicine, Yeungnam University College of Medicine, Daegu, Korea, South E-mail: [email protected] Background and Aims: Acute-on-chronic liver failure (ACLF) is defined differently between Eastern (APASL) and Western countries (EASL-CLIF consortium). This study aimed to investigate the prevalence of ACLF according to the APASL vs. EASL-CLIF definitions as well as short-term mortality. Methods: We collected data for 1470 hospitalized patients (male 1092, median age 55±12 years) with chronic liver disease (CLD) and acute decompensation (AD) from January 2013 to December 2013 from 21 academic hospitals in Korea. Results: The most common underlying cause of CLD was alcohol (63.1%) and the main forms of decompensation were ascites (33.0%) and variceal bleeding (32.2%). The prevalence of ACLF development based on the APASL and EASL-CLIF consortium were 155 (10.5%) and 197 (13.4%) at admission, and 45 (3.1%) and 77 (5.2%) within 28 days of enrollment, respectively. The 28-day and 90-day mortality were higher in patients with ACLF at enrollment than in those without ACLF at enrollment (by APASL definition: 19.4% vs. 4.3%, and 35.7% vs. 6.6%, respectively, P < 0.001; by EASL-CLIF definition: 32.0% vs. 3.9%, and 46.5% vs. 8.4%, respectively, P < 0.001). Of the 207 patients who satisfied the APASL or EASL-CLIF definition at the time of admission, only 54 (26.1%) patients satisfied both definitions, while the remaining patients (73.9%) satisfied only one (with APASL definition, 92 patients; with EASL-CLIF definition, 61 patients). In patients with ACLF, the 28-day and 90-day mortality in patients who satisfied both definitions were significantly higher than in those who satisfied just one definition (44.4% and 53.7%, respectively). The enrolled patients with previous AD within 1 year had higher short-term mortality than those with no previous AD or AD more than 1 year before (28-day mortality: 10.1% vs. 7.8% vs. 5.8%, P = 0.037, 90-day mortality: 20.2% vs. 12.0% vs. 8.8%, P < 0.001). And, of the 118 AD patients at enrollment who had chronic liver disease but not cirrhosis, the 28-day mortality in patients with ACLF at enrollment was not statistically different from that in patients without ACLF at enrollment (by APASL definition: 11.1% vs. 2.8%, P = 0.275, by EASL-CLIF definition: 6.3% vs. 2.9%, P = 0.446). Conclusions: Development of ACLF is associated with high short-term mortality. However, the prevalence and mortality are significantly different when ACLF is defined by the two different APASL vs. EASL-CLIF definitions. Thus, refinement of the two ACLF definitions or a consensus definition is urgently needed.
Journal of Hepatology 2015 vol. 62 | S213–S234
S229
O078 THE PREVALENCE AND MORTALITY OF ACUTE-ON-CHRONIC LIVER FAILURE DEFINED BY APASL VS. EASL–CLIF CONSORTIUM: A MULTICENTER, RETROSPECTIVE COHORT STUDY IN KOREA (KACLIF STUDY) D.S. Song1 , T.Y. Kim2 , D.J. Kim3 , H.Y. Kim1 , D.H. Shinn4 , E.L. Yoon5 , J.H. Sohn2 , C.W. Kim1 , Y.K. Jung6 , K.T. Suk3 , J.M. Yang1 , H.J. Lee7 . 1 Internal medicine, College of Medicine, The Catholic University College of Korea, Seoul, 2 Internal medicine, Hanyang University Guri Hospital, Guri, 3 Internal medicine, Hallym University, Chunchon Sacred Heart Hospital, Chunchon, 4 Internal medicine, Samsung Medical Center, 5 Internal medicine, Inje University Sanggye Paik Hospital, Seoul, 6 Internal medicine, Korea University Ansan Hospital, Ansan, 7 Internal medicine, Yeungnam University College of Medicine, Daegu, Korea, South E-mail: [email protected] Background and Aims: Acute-on-chronic liver failure (ACLF) is defined differently between Eastern (APASL) and Western countries (EASL-CLIF consortium). This study aimed to investigate the prevalence of ACLF according to the APASL vs. EASL-CLIF definitions as well as short-term mortality. Methods: We collected data for 1470 hospitalized patients (male 1092, median age 55±12 years) with chronic liver disease (CLD) and acute decompensation (AD) from January 2013 to December 2013 from 21 academic hospitals in Korea. Results: The most common underlying cause of CLD was alcohol (63.1%) and the main forms of decompensation were ascites (33.0%) and variceal bleeding (32.2%). The prevalence of ACLF development based on the APASL and EASL-CLIF consortium were 155 (10.5%) and 197 (13.4%) at admission, and 45 (3.1%) and 77 (5.2%) within 28 days of enrollment, respectively. The 28-day and 90-day mortality were higher in patients with ACLF at enrollment than in those without ACLF at enrollment (by APASL definition: 19.4% vs. 4.3%, and 35.7% vs. 6.6%, respectively, P < 0.001; by EASL-CLIF definition: 32.0% vs. 3.9%, and 46.5% vs. 8.4%, respectively, P < 0.001). Of the 207 patients who satisfied the APASL or EASL-CLIF definition at the time of admission, only 54 (26.1%) patients satisfied both definitions, while the remaining patients (73.9%) satisfied only one (with APASL definition, 92 patients; with EASL-CLIF definition, 61 patients). In patients with ACLF, the 28-day and 90-day mortality in patients who satisfied both definitions were significantly higher than in those who satisfied just one definition (44.4% and 53.7%, respectively). The enrolled patients with previous AD within 1 year had higher short-term mortality than those with no previous AD or AD more than 1 year before (28-day mortality: 10.1% vs. 7.8% vs. 5.8%, P = 0.037, 90-day mortality: 20.2% vs. 12.0% vs. 8.8%, P < 0.001). And, of the 118 AD patients at enrollment who had chronic liver disease but not cirrhosis, the 28-day mortality in patients with ACLF at enrollment was not statistically different from that in patients without ACLF at enrollment (by APASL definition: 11.1% vs. 2.8%, P = 0.275, by EASL-CLIF definition: 6.3% vs. 2.9%, P = 0.446). Conclusions: Development of ACLF is associated with high short-term mortality. However, the prevalence and mortality are significantly different when ACLF is defined by the two different APASL vs. EASL-CLIF definitions. Thus, refinement of the two ACLF definitions or a consensus definition is urgently needed.
Journal of Hepatology 2015 vol. 62 | S213–S234
S229