SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Direct acting oral anticoagulants are increasingly used in the treatment of venous thromboembolism including deep venous thrombosis and pulmonary embolism, however their use in patients with cirrhosis is unclear Patients with cirrhosis were excluded from the clinical trials conducted for DOACs and DOACs are currently not approved for use in Child Class C cirrhosis, and data on these patients remains very scarce METHODS: In this retrospective cohort study, we compared the clinical outcomes of cirrhotics treated with DOACs and Warfarin for DVT or PE at our institute. RESULTS: A total of 225 patients with cirrhosis on anticoagulation for DVT or PE were included for analysis, of which 113 were female (50.2%). Of these patients, 176 patients and 55 patients were diagnosed with DVT and PE at the time of anticoagulant initiation respectively (6 patients had both). 73 patients (32.4%) were prescribed warfarin while 152 patients received DOACs (67.6%). Eliquis was the most frequent DOAC (84 patients), followed by Xarelto (68 patients). 66 patients (29.3%) had advanced (Child C) cirrhosis; 26 patients in warfarin and 40 in DOAC group respectively. 37 patients (16.4%) experienced a significant bleeding event during follow up. There was no difference in the rate of bleeding in the two groups; 25 patients in DOAC group and 12 patients in warfarin group (16.4% in both separate groups). Univariate analysis revealed that type of anticoagulant (p = 0.999), indication (p = 0.66), gender (p = ), concurrent antiplatelets (p = 0.89), presence of varices (p = 0.62), platelet level (p = 0.36) were not associated with bleeding events while presence of advanced (Child C cirrhosis) was associated with bleeds at follow up (p = 0.015). Multivariable logistic regression model was fitted incorporating age, time on anticoagulant, antiplatelet therapy, child C cirrhosis, and type of anticoagulant as covariates and bleeds at follow up as dependent variable. Only Child C cirrhosis was found to be independently linked to increased risk of bleed (OR: 2.46, 95% CI 1.18 – 5.12). Prescription of DOAC compared to warfarin was not linked to bleeding (OR 1.16, 95% CI 0.53 – 2.52). A total of 5 patients experienced failure of anticoagulation (recurrent thromboembolism while anticoagulated); 2 in DOAC group and 3 patients in warfarin group. CONCLUSIONS: No difference in bleeding rates was found between DOAC and Warfarin groups in patients with cirrhosis anticoagulated for DVT and PE, including patients with Child Class C cirrhosis. Patients with Child C cirrhosis are more likely to bleed compared to those with Child Class and A and B cirrhosis. CLINICAL IMPLICATIONS: DOAC use is unstudied in Child C cirrhosis and is currently not approved. Our study adds vital new data elucidating safety and efficacy of DOAC use in patients with cirrhosis for these indications. DISCLOSURES: No relevant relationships by Sana Ali, source=Web Response No relevant relationships by Yousaf Hadi, source=Web Response No relevant relationships by Ali Khan, source=Web Response no disclosure on file for Justin Kupec; No relevant relationships by Dhairya Lakhani, source=Web Response No relevant relationships by Syeda Fatima Naqvi, source=Web Response No relevant relationships by FNU Rida Ul Jannat, source=Web Response