Retrospective analysis of the efficacy and safety of rivaroxaban in the treatment of hepatic sinus obstruction syndrome caused by Gynura segetum

Abstract

Background and Objective: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a rare disease with no specific treatment. Anticoagulants, antithrombotics, and microcirculation therapy can alleviate the progression of PA-HSOS. The application of rivaroxaban in patients with PA-HSOS has not yet been reported. The aim of this study was to analyze the efficacy and safety of rivaroxaban in the treatment of PAHSOS caused by Gynura segetum. Methods: A retrospective analysis was conducted using the clinical data of patients with PA-HSOS in the acute/subacute phase caused by the administration of Gynura segetum. The patients were divided into warfarin and rivaroxaban groups according to the anticoagulant therapy they received. The related biochemical indicators were monitored during hospitalization. Liver ultrasound, liver elastography, and related biochemical indicators were reviewed every two weeks or one month after discharge. The patients were followed until 1 year after complete remission or death. The efficacy and safety of rivaroxaban was compared with that of warfarin according to the patients’ hepatic venous recanalization rates and the occurrence of bleeding events. Results: The study included 20 patients, with 10 in the warfarin group and 10 in the rivaroxaban group. The results show that the average anticoagulant course in the rivaroxaban group was significantly shorter than that in the warfarin group (P = 0.007). With treatment, the remission rates of the rivaroxaban and warfarin groups reached 90%. There was no significant difference in the incidence of adverse reactions or bleeding events between the t wo groups (P ＞ 0.05). Conclusions: Compared with warfarin, rivaroxaban, a new oral anticoagulant, is convenient and safe for clinical use. It has a significant effect on PA-HSOS and a low risk of bleeding. This provides a new anticoagulant treatment for PA-HSOS.