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Are DOACs Actually Safer in Advanced Cirrhosis – RPTH Journal
RPTH Journal /LinkedIn
Feb 11, 2026, 16:35

Are DOACs Actually Safer in Advanced Cirrhosis – RPTH Journal

RPTH Journal shared a post on LinkedIn about a recent article by Daniel Tham et al, adding:

“Are DOACs actually safer in advanced cirrhosis?

For years, anticoagulation in Child-Pugh B/C cirrhosis has lived in the “too risky / not enough data” zone. This new meta-analysis pushes that conversation forward in a big way.

Across 16 studies and >17,000 patients, DOACs were compared with warfarin/LMWH in cirrhosis.

Here’s what stood out

Major bleeding was LOWER with DOACs

  • CP B/C subgroup: OR 0.53
  • Overall cohort: OR 0.60
  • No increase in VTE recurrence or stroke risk
  • Minor bleeding also trended lower overall

Translation: DOACs may not just be convenient; they may actually be safer than traditional anticoagulation in cirrhosis.

But here’s the nuance:

Most data remain observational, and evidence in Child-Pugh C is still limited. We’re seeing strong signals, not the final word.

This is exactly the type of evidence clinicians have been waiting for to guide real-world decision-making in a notoriously difficult population.”

Title: Safety and efficacy of direct oral anticoagulants in patients with liver cirrhosis: a meta-analysis

Authors: Daniel Tham, Wenhui Yu, Lucy Zhao, Roger Kou, Jayhan Kherani, Pei Yi Li, Shreyas Sreeraman, Ali Eshaghpour, Allen Li, Mark A. Crowther

Read the Full Article on RPTH Journal.

RPTH Journal

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Ali Eshaghpour Allen Li Daniel Tham DOAC DOACs Hematology Hemostasis Today Jayhan Kherani LMWH Lucy Zhao major bleeding Mark A. Crowther Medicine Pei Yi Li Roger Kou RPTH Journal Shreyas Sreeraman Warfarin Wenhui Yu
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