{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:46:50Z","timestamp":1792838810533,"version":"4.5.0"},"reference-count":90,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>\n            Background\u2003Direct oral anticoagulants (DOACs) are effective for the management of thromboembolic disorders. However, bleeding remains a major concern in cirrhotic patients receiving DOACs.<\/jats:p><jats:p>\n            Methods\u2003PubMed, EMBASE, and Cochrane Library databases were searched. The incidence of bleeding episodes in cirrhotic patients receiving DOACs was pooled. Odds ratios (ORs) were calculated to compare the incidence of bleeding episodes in cirrhotic patients who received DOACs versus those who received conventional anticoagulants and did not receive anticoagulants.<\/jats:p><jats:p>\n            Results\u2003Twenty-nine studies were included. All bleeding, major bleeding, fatal bleeding, gastrointestinal bleeding, and intracranial hemorrhage episodes were observed in 310\/2,469, 100\/1,388, 2\/611, 166\/1,886, and 5\/1,147 cirrhotic patients receiving DOACs, respectively. Their pooled incidences were 13, 6, 0, 8, and 0%, respectively. They became higher in subgroup analyses of studies with advanced age, a longer treatment duration, and Child\u2013Turcotte\u2013Pugh class C. Compared with conventional anticoagulants, DOACs were associated with lower incidences of all bleeding (OR\u2009=\u20090.71, 95% confidence interval [CI]\u2009=\u20090.52\u20130.98) and major bleeding (OR\u2009=\u20090.55, 95% CI\u2009=\u20090.37\u20130.83) in cirrhotic patients, but not those of fatal bleeding (OR\u2009=\u20090.21, 95% CI\u2009=\u20090.04\u20131.28), gastrointestinal bleeding (OR\u2009=\u20090.78, 95% CI\u2009=\u20090.52\u20131.17), or intracranial hemorrhage (OR\u2009=\u20090.36, 95% CI\u2009=\u20090.12\u20131.12). The incidences of all bleeding (OR\u2009=\u20091.04, 95% CI\u2009=\u20090.22\u20134.79) and major bleeding (OR\u2009=\u20090.96, 95% CI\u2009=\u20090.26\u20133.61) did not significantly differ between cirrhotic patients with portal vein thrombosis (PVT) who received DOACs and those who did not receive anticoagulants.<\/jats:p><jats:p>\n            Conclusion\u2003DOACs carry a low risk of bleeding in liver cirrhosis. Age, treatment duration, and Child\u2013Turcotte\u2013Pugh class may be associated with bleeding in cirrhotic patients receiving DOACs. The risk of bleeding is not increased by DOACs in cirrhotic patients with PVT.<\/jats:p>","DOI":"10.1055\/s-0043-1770100","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T23:08:40Z","timestamp":1687216120000},"page":"1072-1088","source":"Crossref","is-referenced-by-count":22,"title":["Risk of Bleeding in Liver Cirrhosis Receiving Direct Oral Anticoagulants: A Systematic Review and Meta-analysis"],"prefix":"10.1055","volume":"123","author":[{"given":"Zhe","family":"Li","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Xu","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Wang","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Postgraduate College, China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Chai","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Ageno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Gomes","family":"Romeiro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Botucatu Medical School, S\u00e3o Paulo State University (UNESP), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyu","family":"Li","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China"},{"name":"Postgraduate College, China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingshun","family":"Qi","sequence":"additional","affiliation":[{"name":"Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China"},{"name":"Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China"},{"name":"Postgraduate College, China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,6,19]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ejim.2022.05.032","article-title":"Epidemiology of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis","volume":"104","author":"J Pan","year":"2022","journal-title":"Eur J Intern Med"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s11739-014-1163-7","article-title":"Epidemiology of venous thromboembolism in patients with liver diseases: a systematic review and meta-analysis","volume":"10","author":"X Qi","year":"2015","journal-title":"Intern Emerg Med"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1160\/TH16-06-0450","article-title":"The risk of venous thromboembolism in patients with cirrhosis. 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