The in vivo effect of apixaban and edoxaban in patients with liver cirrhosis: pharmacological parameters

Introduction Liver cirrhosis (LC) is associated with relevant morbidity and mortality. Emerging data suggest an improved outcome in LC patients on long-term anticoagulation. Since the use of direct oral anticoagulants (DOAC) is limited in this vulnerable population, our aim was to investigate pharmacological parameters of two DOAC in LC patients. Method This is a monocentric clinical trial (NCT05869591) with non-anticoagulated Child A and Child B LC patients, randomised to receive either edoxaban 60 mg once daily or apixaban 5 mg twice daily for 7 days. Pharmacokinetic and pharmacodynamic parameters are measured in vivo and ex vivo at day(d)1, d3, d8 and d9. Here, we present preliminary results (edoxaban n=18, apixaban n=16) of ex vivo thrombin generation (TG) assessed by ST Genesia DrugScreen and ThromboScreen (Stago, France), and in vivo markers of coagulation activity (D-dimers, DD; thrombin-antithrombin complexes, TAT; prothrombin fragments 1+2, F1+2). Results Compared to non-anticoagulated baseline, DOAC induced significant reductions in ex vivo TG parameters (velocity index [VI], peak height [PH] and time to peak; p