Liver injury caused by oral anticoagulants: A population-based retrospective cohort study.

To access publisher's full text version of this article click on the hyperlink below Background & aims: Idiosyncratic drug-induced liver injury (DILI) is a rare adverse event. DILI caused by direct oral anticoagulants (DOACs) has been reported, however, data on the risk of DILI are limited....

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Bibliographic Details
Published in:Liver International
Main Authors: Björnsson, Helgi K, Gudmundsson, David O, Björnsson, Einar S
Other Authors: 1Department of Internal Medicine, Section of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland. 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Format: Article in Journal/Newspaper
Language:English
Published: Wiley 2020
Subjects:
anticoagulation
drug reactions
hepatotoxicity
Segavarnarlyf
Lifrarsjúkdómar
Aukaverkanir lyfja
Chemical and Drug Induced Liver Injury
Anticoagulants
Iceland
Online Access:http://hdl.handle.net/2336/621490
https://doi.org/10.1111/liv.14559
Description
Summary:To access publisher's full text version of this article click on the hyperlink below Background & aims: Idiosyncratic drug-induced liver injury (DILI) is a rare adverse event. DILI caused by direct oral anticoagulants (DOACs) has been reported, however, data on the risk of DILI are limited. The aim of the study was to evaluate the frequency of DILI caused by oral anticoagulants (OACs) in a population-based setting. Methods: A computerized database search in The National Prescription Database was performed identifying all patients in Iceland who were prescribed OACs (rivaroxaban, apixaban, dabigatran, edoxaban or warfarin) in 2008-2017. Personal identification numbers of these patients were linked with a database containing laboratory results for all hospitals and most outpatient clinics in Iceland. A medical chart review was performed in all cases where onset of liver injury followed intake of OACs. Patients with other specific causes of liver injury were excluded. Causality assessment with the RUCAM method was undertaken in cases with suspected DILI. Results: Three cases of suspected DILI were identified. In all cases, rivaroxaban was the implicated agent among patients prescribed this product (n = 3446). All were women with a hepatocellular type of liver injury. One patient developed a suspected drug-induced autoimmune hepatitis and was treated with corticosteroids. No cases of DILI in patients on warfarin (n = 9101), apixaban (n = 1903), dabigatran (n = 1335) and edoxaban (n = 34) were identified. Conclusions: Rivaroxaban was the only OAC associated with DILI during the 10-year study period. Approximately 1 in 1100 patients treated with rivaroxaban developed DILI. Other OACs were not associated with liver injury in this population-based study. Keywords: anticoagulation; drug reactions; hepatotoxicity. Landspitali University Hospital

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