Sarah Bos

38 CHAPTER 3 Abstract Background: cirrhosis is complicated by bleeding and thrombotic events. Using vitamin K antagonists (VKA) and low-molecular weight heparin (LMWH) in cirrhotic patients has major drawbacks. Direct oral anticoagulants (DOAC) might be promising for this specific group of patients. Little evidence exists on hemostatic effect in cirrhosis let alone on the different etiologies. The in vitro effect of DOAC will be compared to traditional anticoagulants in blood samples of patients with non-alcoholic steatohepatitis (NASH) versus alcoholic steatohepatitis (ASH) cirrhosis with blood samples from lean and obese volunteers as controls. Methods: twenty-two blood samples of patients with NASH-cirrhosis and 15 samples of patients with ASH-cirrhosis were compared. Twenty samples of lean and obese subjects were included as well. The potency of LMWH, Dabigatran and Apixaban were examined by performing thrombin generation tests. Results: similar results were seen between NASH and ASH-cirrhosis for LMWH and dabigatran. Apixaban had a significantly different endogenous thrombin potential (ETP) decrease compared between the samples of NASH and ASH cirrhosis. Similar results for apixaban are reported for the obese group when compared with NASH cirrhosis. However for dabigatran and LMWH there was a great variation in values of peak time and velocity between NASH-cirrhosis and the controls. Conclusions: the in vitro effect of the different anticoagulant therapy in blood samples from patient with NASH and ASH cirrhosis shows no difference.