{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:15:38Z","timestamp":1787015738654,"version":"build-2736575974"},"reference-count":11,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Treatment for hepatitis C virus (HCV) with direct\u2010acting antivirals (DAA) is advantageous over previous treatment options due to high efficacy, short treatment duration, and relatively few drug interactions. Similarly, direct oral anticoagulants (DOAC) are generally preferred over warfarin for the management of thrombosis and atrial fibrillation due to a favourable safety profile. Direct\u2010acting antivirals inhibit DOAC transport through P\u2010glycoprotein inhibition leading to a theoretical increase in bleeding risk. We evaluated the incidence of bleeding in patients who received concurrent DAA and DOAC therapy and stratified the analysis based on the patient's cirrhosis status. We conducted a multicenter, retrospective cohort study to evaluate bleeding in patients with HCV and cirrhosis compared to patients with HCV without cirrhosis. Patients receiving at least 1\u2009month of overlapping DAA and DOAC therapy between May 2017 and August 2020 at 11 medical centers in the United Kingdom and three medical centers in the United States were included. Charts were manually reviewed to identify baseline characteristics as well as thromboembolic or bleeding events. Bleeding events were categorized as major bleeding (MB) and clinically relevant non\u2010major bleeding (CRNMB). Of 204 total patients, 36 patients (18%) had cirrhosis and 168 patients (82%) did not have cirrhosis. The majority of patients were male (79%) and Caucasian (75%). Sofosbuvir\/velpatasvir (32%) and rivaroxaban (57%) were the most commonly prescribed DAA and DOAC, respectively. Leading indications for anticoagulation included thrombosis (75%) and atrial fibrillation (21%). There were three MB events (1.5%) all of which occurred in patients with additional risk factors (age over 65 and on antiplatelet therapy) and no CRNMB occurred while on DOAC and DAA therapy. Of the three MB, one occurred in a patient with cirrhosis and two in patients without cirrhosis, RR 1.23 (0.56\u20132.76). In conclusion, in this multicenter cohort study of concurrent DAA and DOAC use, MB was uncommon and there was no CRNMB. There was no significant difference in bleeding events among patients with cirrhosis compared to those without cirrhosis. These findings support the use of DAA among patients requiring DOAC.<\/jats:p>","DOI":"10.1111\/jvh.13750","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T14:24:33Z","timestamp":1663165473000},"page":"1073-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Safe co\u2010administration of direct\u2010acting antivirals and direct oral anticoagulants among patients with hepatitis C virus infection: An international multicenter retrospective cohort study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4204-0919","authenticated-orcid":false,"given":"Kathryn","family":"McDaniel","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy Grady Health System  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa E.","family":"Utz","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Grady Health System  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1236-8788","authenticated-orcid":false,"given":"Mikhail","family":"Akbashev","sequence":"additional","affiliation":[{"name":"Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1571-8122","authenticated-orcid":false,"given":"Katherine G.","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Viral Hepatology Emory Healthcare  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-9755","authenticated-orcid":false,"given":"Alison","family":"Boyle","sequence":"additional","affiliation":[{"name":"Gartnavel General Hospital  Glasgow UK"},{"name":"University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Davidson","sequence":"additional","affiliation":[{"name":"Western General Hospital  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1326-1149","authenticated-orcid":false,"given":"Fiona","family":"Marra","sequence":"additional","affiliation":[{"name":"Gartnavel General Hospital  Glasgow UK"},{"name":"University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sital","family":"Shah","sequence":"additional","affiliation":[{"name":"King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2954-5106","authenticated-orcid":false,"given":"Emily J.","family":"Cartwright","sequence":"additional","affiliation":[{"name":"Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Veterans Affairs  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakriti A.","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8282-8984","authenticated-orcid":false,"given":"Sarah","family":"DuPont","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8660-8732","authenticated-orcid":false,"given":"Lesley S.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27259"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.12.032"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13459"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2019.03.009"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.5604\/01.3001.0010.0279"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40261-020-00962-y"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0618-8278(19)30405-0"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13140"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.052"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy585"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp11X613115"}],"container-title":["Journal of Viral 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