THROMBOTIC EVENTS IN PATIENTS WITH HEPATITIS C VIRUS LIVER CIRRHOSIS TREATED WITH DIRECT ACTING ANTIVIRALS AND SUSTAINED VIROLOGICAL RESPONSE

  • Laura HUIBAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Cristina Maria MUZICA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • T. CUCIUREANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • S. CHIRIAC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • F. MIHAI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C. SFARTI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ana Maria SINGEAP “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina GIRLEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C. STANCIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca TRIFAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

The advent of direct-acting antivirals (DAAs) is a major breakthrough in hepatology representing the therapeutical standard of care in patients with chronic hepatitis C virus infection over the past few years. Despite high rates of sustained virological response (SVR), DAAs therapy doesn’t eliminate the risk of thrombotic events. Aim: We aimed to assess the incidence and risk factors of thrombotic events in patients with SVR treated with DAAs. Material and methods: We retrospectively analyzed a cohort of patients with HCV-related liver cirrhosis treated with paritaprevir/ritonavir, ombitasvir and dasabuvir (PrOD) ± ribavirin and ledipasvir/sofosbuvir (LED/SOF) ± ribavirin for 12/24 weeks, in a tertiary gastroenterology referral center from North-Eastern Romania, between January 1st 2016 and January 1st 2018. All patients with presumption of thrombosis were evaluated by vascular Doppler, abdominal ultrasound and confirmed by CT scan. Results: The study included 321 HCV-infected cirrhotic patients treated with PrOD or LED/SOF, with documented SVR, mean age 59,7 ± 8,5 years, predominantly female (59%). Of the total number, 307 (95.63%) received PrOD and 14 (4.36%) patients were treated with LED/SOF. Mean period from SVR and the occurrence of thrombotic events was 250±123 days. Thrombotic complications were reported in 14 (4.36%) patients: 4 (28.57%) with deep vein thrombosis, 4 (28.57%) with portal vein thrombosis (PVT), 6 (42.85%) with malignant PVT. All patients had associated cardiovascular (8- 57.14%) and metabolic comorbidities (6- 42.85%). The main clinical manifestations at diagnosis were: swelling, edema, erythema and lower limb pain in 4 patients, upper digestive hemorrhage in 2 patients, ascitic decompensation in 4 patient and 4 patients were asymptomatic. Biologically there was no significant change in prothrombin serum levels (baseline values in patients treated with PrOD was 11.67 ± 0.91 versus 11.70 ± 0.83 at SVR, p=0.993, respectively 11.5 ± 0.84 sec at baseline versus 11.4 ± 0.68 at SVR, p=0.715 in patients treated with LED/SOF+RBV) and platelet count (126 000 (101 500-162 000)          vs. 131 000 (101 000-165 000), p= 0.818 in patients treated with PrOD, respectively 94857.14  ± 32 vs. 92428.57 ± 35, p= 0.853, in patients treated with LED/SOF+RBV). Conclusions: We conclude that thrombotic events in patients with HCV-related liver cirrhosis treated with DAAs are not influenced by the variations of coagulation parameters, rather correspond to the hypercoagulability status of the cirrhotic patient.

Author Biographies

Laura HUIBAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

Cristina Maria MUZICA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

T. CUCIUREANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

S. CHIRIAC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

F. MIHAI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)

C. SFARTI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

Ana Maria SINGEAP, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

Irina GIRLEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

C. STANCIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

Anca TRIFAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Romania
Institute of Gastroenterology and Hepatology

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Published
2018-04-04