{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:14:42Z","timestamp":1790694882078,"version":"4.1.0"},"reference-count":61,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemostasis in cirrhosis is a dynamic, \u201crebalanced\u201d state rather than a simple bleeding diathesis. Portal vein thrombosis (PVT) is a frequent complication linked to variceal bleeding, hepatic decompensation, and mortality. Anticoagulation can prevent thrombus progression, promote recanalization, and improve survival without a major increase in bleeding risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To summarize the safety, efficacy, and pharmacologic considerations of direct oral anticoagulants (DOACs) for PVT in cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review is informed by a systematic literature search (Ovid Medline, Ovid EMBASE, Cochrane Central, Cochrane Database of Systematic Reviews, and Scopus) from 2010 to 17 July 2025. We included cohort, interventional, and meta-analytic studies evaluating DOACs in adults with cirrhosis and PVT, and synthesized these with pharmacokinetic data and international guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fixed-dose oral DOACs, with generally favorable safety profiles, are promising alternatives to vitamin K antagonists (VKAs) and low-molecular-weight heparins. Regulatory guidance supports DOAC use in Child\u2013Turcotte\u2013Pugh (CTP) class A, recommends cautious use in selected CTP class B patients, and generally discourages use in CTP class C. Apixaban and edoxaban show relatively stable pharmacokinetics in compensated cirrhosis. Observational cohorts and network meta-analyses suggest that DOACs achieve at least comparable, and often higher, rates of portal vein recanalization than VKAs, with similar risks of major and variceal bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, DOACs represent an effective and convenient anticoagulation option for carefully selected cirrhotic patients with PVT. Treatment should be individualized according to liver and renal function, variceal status, and transplant candidacy. High-quality prospective studies are still needed, particularly in CTP classes B\/C cirrhosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296261420229","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T17:39:26Z","timestamp":1770140366000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Direct Oral Anticoagulants for Portal Vein Thrombosis in Cirrhosis: From Pharmacology to Clinical Practice"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-266X","authenticated-orcid":false,"given":"Khalid M.","family":"Al Naamani","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology &amp; Hepatology, The Medical City for Military and Security Services, Muscat, Oman"},{"name":"Steatotic Liver Disease Foundation in Middle East and North Africa (SLMENA), Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundus","family":"Rizwan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology &amp; Hepatology, The Medical City for Military and Security Services, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siham","family":"Al Sinani","sequence":"additional","affiliation":[{"name":"Sultan Qaboos University Hospital"},{"name":"Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5821-1087","authenticated-orcid":false,"given":"Bader","family":"Al Rawahi","sequence":"additional","affiliation":[{"name":"Sultan Qaboos University Hospital, Sultan Qaboos University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheikha","family":"AlMa\u2019mari","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Medical City for Military and Security Services, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"El-Kassas","sequence":"additional","affiliation":[{"name":"Steatotic Liver Disease Foundation in Middle East and North Africa (SLMENA), Cairo, Egypt"},{"name":"Helwan University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31646"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i19.5737"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2022.05.032"},{"key":"e_1_3_2_5_2","first-page":"1","article-title":"Surgery and portal hypertension","volume":"1","author":"Child CG","year":"1964","unstructured":"Child CG, Turcotte JG. 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