P1790 - Direct-Acting Oral Anticoagulant and Warfarin Use in Patients With Advanced Cirrhosis

Adnan A. Khan, MD¹, Yousaf B. Hadi, MD², Syeda F. Naqvi, MD², Ali Younas Khan, MD³, Raja Samir Khan, MD², Rida Jannat, MD², Yasir Al-Azzawi, MD², Dhairya Lakhani, MD², Ashwani Singal, MD, FACG⁴, Justin Kupec, MD, FACG^5
1Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²West Virginia University School of Medicine, Morgantown, WV; ³Saint Joseph Mercy Oakland, Pontiac, MI; ⁴University of South Dakota Sanford School of Medicine, Sioux Falls, SD; ⁵West Virginia University, Morgantown, WV

Introduction: DOACs are increasingly used for various indications, however their use in patients with advanced cirrhosis is unclear. Patients with cirrhosis have been excluded from the clinical trials conducted for DOACs, and these agents are currently not approved for use in Child C cirrhosis due to the limited available data. Our aim was to study the use of DOACs in advanced cirrhosis.

Methods: We performed a retrospective cohort study of all patients with cirrhosis who were prescribed anticoagulant agents at our tertiary care university hospital from 2010 to 2018 and compared clinical outcomes between DOAC and Warfarin prescriptions. Log-Rank tests and Cox-proportional Hazard analysis was conducted to assess bleeding rates in the two groups. Subgroup analysis was conducted for Child C cirrhosis.

Results: A total of 614 patients with cirrhosis were included, including 192 patients with Child Class C cirrhosis. The Warfarin and DOAC groups were well matched in demographic and clinical baseline characteristics. Mean MELD-Na score (p=0.08) and proportion with Child C cirrhosis (p=0.045) were higher in Warfarin group. Two hundred fifty-eight patients suffered bleeding events on anticoagulation. All- cause bleeding rates were similar between DOAC and warfarin patients. The choice of DOAC as anticoagulant was not associated with bleeding. Subgroup analysis was conducted for the Child A+B and Child C cirrhosis cohorts. There was no difference between the DOAC and Warfarin groups in the bleed-free survival curves for all-bleeding and major-bleeding.

Discussion: DOACs are comparable in bleeding profile to Warfarin in patients with cirrhosis including those with Child C cirrhosis.


Disclosures:


Adnan A. Khan, MD¹, Yousaf B. Hadi, MD², Syeda F. Naqvi, MD², Ali Younas Khan, MD³, Raja Samir Khan, MD², Rida Jannat, MD², Yasir Al-Azzawi, MD², Dhairya Lakhani, MD², Ashwani Singal, MD, FACG⁴, Justin Kupec, MD, FACG⁵. P1790 - Direct-Acting Oral Anticoagulant and Warfarin Use in Patients With Advanced Cirrhosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.