A Commentary on ‘Safety of Anticoagulation When Undergoing Endoscopic Variceal Ligation: A Systematic Review and Meta‐Analysis’

Liver International, Journal Year: 2025, Volume and Issue: 45(3)

Published: Feb. 21, 2025

We are interested in the article, 'Safety of Anticoagulation When Undergoing Endoscopic Variceal Ligation: A Systematic Review and Meta-Analysis' published your journal [1]. This study demonstrated by means a meta-analysis that continuing anticoagulation cirrhotic patients undergoing endoscopic variceal ligation (EVL) does not significantly increase risk bleeding supports routine non-need to discontinue elective EVL. would like commend authors for their work offer some suggestions. First, article did adequately explore possible impact therapy combination with other medications on bleeding. For example, cirrhosis often need concurrently use such as diuretics, antibiotics antihypertensives, which may interact anticoagulants, thereby affecting effectiveness or increasing [2]. Failure consider these combinations lead an underestimation overestimation effect anticoagulant therapy. Second, although concludes is safe during EVL, clinical application this conclusion requires caution. Differences healthcare resources, skill levels patient populations (e.g., race, age comorbidities) different regions affect efficacy safety The findings be applicable all hospitals populations, so further multicentre, large-scale studies needed verify generalisability findings. Finally, included data from follow-up times ranging 30 days 5 years, majority had shorter times. long-term effects anticoagulation, complications hepatic failure have been evaluated over long term many studies. necessary improve reliability results. Overall, provides important evidence EVL has greater significance. It hoped future will address existing limitations contribute development field. Zhenwei Wang Ying Zhu were responsible literature collection drafting paper. Liangliang Chen supervised study. All read approved final version manuscript. declare no conflicts interest. nothing report.

Language: Английский

Author's Reply: Commentary on Safety of Anticoagulation When Undergoing Endoscopic Variceal Ligation

Liver International, Journal Year: 2025, Volume and Issue: 45(3)

Published: Feb. 21, 2025

We appreciate the valuable thoughts of Wang et al. [1] on our recent meta-analysis demonstrating safety anticoagulation when undergoing endoscopic variceal ligation (EVL) [2]. author's concern about how potential impact limited long-term follow-up might affect reliability results. However, it is important to note that as more time passes after (EVL), becomes increasingly challenging establish a clear cause-and-effect relationship between therapy and outcomes we studied. Consequently, unreliable attribute bleeding events occurring years solely singular decision whether was continued or discontinued during EVL. Moreover, post-banding ulcer typically occurs 10 14 days EVL patients have already resumed their anticoagulation, thus questioning need for routine cessation in To address biases arising from variability periods across studies, specifically defined study (rebleeding bleeding-related mortality) within 6 weeks The author suggested report concurrent use with other medications conduct subgroup analyses based patient characteristics, these factors may influence anticoagulation. could not perform because insufficient detail among studies included. Estimating effectiveness conventional parameters such international normalised ratio (INR) cirrhosis misleading decompensated experience rebalanced haemostasis reduced production both pro- anti-coagulant [3]. INR does fully capture risk (fibrinolysis, platelet function endothelial dysfunction), but often reflects underlying liver dysfunction [4]. For reasons, current guidance also recommends against using alone guide pre-emptive transfusion prior invasive procedures [5]. Finally, agree decisions regarding without EVL, should always be individualised. Current showed increase pooled rebleeding (OR, 1.10; 95% CI: 0.85–1.42, I2 = 0%; 5 n 5427) 0.94; 0.31–2.85, 3 4887) suggesting discontinuation necessary. As GRADE summary low certainty evidence available, further well-designed are needed enhance understanding (particularly direct-acting oral anticoagulants) Study conception: Y.J.W. Manuscript draft: J.H.L., J.W.E.Q., Critical review manuscript final review: All authors. authors nothing report. declare no conflicts interest.

Language: Английский

A Systematic Review of Factor XI/XIa Inhibitors Versus Direct Oral Anticoagulants in Patients with Atrial Fibrillation

Clinical and Applied Thrombosis/Hemostasis, Journal Year: 2025, Volume and Issue: 31

Published: April 1, 2025

Background Atrial fibrillation (AF) is a leading cause of stroke, necessitating effective anticoagulation. While direct oral anticoagulants (DOACs) have improved stroke prevention, bleeding risks remain concern. Factor XI/XIa inhibitors, targeting the intrinsic coagulation pathway, offer potential for reduced bleeding, although questions regarding their efficacy. This systematic review evaluates efficacy and safety inhibitors compared to DOACs in AF patients. Methods We conducted randomized controlled trials (RCTs) comparing with patients, identified through PubMed Embase up January 2025. Data were synthesized narratively due heterogeneity study designs outcomes. Results Three RCTs (AZALEA-TIMI 71, OCEANIC-AF, PACIFIC-AF) involving 16 852 patients included. (abelacimab asundexian) demonstrated significant reductions DOACs. In AZALEA-TIMI abelacimab major or clinically relevant non-major by 62%-69% versus rivaroxaban. PACIFIC-AF, asundexian 50%-84% apixaban. However, OCEANIC-AF showed was inferior 3.8-fold higher risk systemic embolism apixaban, early trial termination. Abelacimab trend toward ischemic rates (150 mg: 1.21 vs 0.59 events/100 person-years; 90 1.24 person-years), though not statistically significant. Conclusion significantly reduce DOACs, but thrombotic remains uncertain. promising, further research needed optimize use.

Language: Английский