Effect of Rivaroxaban on hemostasis in patients with alcoholic cirrhosis of the liver in combination with obesity

Abstract

The effect of rivaroxaban on hemostasis was investigated in patients with alcoholic liver cirrhosis (ALC) in combination with obesity and non-valvular atrial fibrillation (NVAF). The study included 48 obese patients with ALC of class A (according to the Child-Pugh score) with NVAF, who were not previously treated with direct oral anticoagulants. There are 43 men and 5 women aged 35 to 64 years, mean age is (54.2±4.8) years. Depending on the treatment, patients were divided into two groups: group I included 22 patients who received oral anticoagulant rivaroxaban at a dose of 10 mg/day for 12 months, group II included 26 patients who received basic therapy without rivaroxaban for 12 months. Assessment of the patients’ condition was performed before treatment, 12, 24 and 48 weeks after treatment onset. The severity of LC was assessed according to the Child-Pugh and the MELD scores. Stratification of the risk of bleeding was performed according to the HAS-BLED score. It is shown, that in obese patients with ALC of class A according to the Child-Pugh score in the presence of NVAF, the use of rivaroxaban in combination therapy for 48 weeks contributed to the positive dynamics of hemostasis: decreased factor VIII activity, von Willebrand factor activity, reduced plasminogen activator inhibitor-1, D-dimer levels (p<0.05) and an increase in the activity of protein C (p<0.05), which was accompanied by a moderate decrease in the Child-Pugh and the MELD scores, and this was not observed in the comparison group. The use of rivaroxaban in this cohort of patients for 48 weeks did not increase the risk of major bleeding according to the clinical course and the HAS-BLED score. It is proved that the use of rivaroxaban in the complex treatment of patients with ALC of class A (according to the Child-Pugh score) in combination with obesity and NVAF, contributes to the positive dynamics of hemostasis with a reduced risk of hypercoagulation. Such therapy does not increase the risk of major bleeding at the stage of compensation of ALC in combination with obesity and NVAF.