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Rivaroxaban May Improve Outcomes in Cirrhosis

Rivaroxaban May Improve Outcomes in Cirrhosis

Medscape25-07-2025
TOPLINE:
Rivaroxaban improved portal hypertension-related complication-free survival in patients with cirrhosis and moderate liver dysfunction, without significantly increasing the risk for major bleeding events.
METHODOLOGY:
Researchers conducted a randomised trial of 90 patients with cirrhosis, portal hypertension, and moderate liver dysfunction (on the basis of the Child-Pugh score) who were enrolled at 14 hospitals in Spain between May 2016 and October 2020 to assess the improvement in outcomes with rivaroxaban.
Patients were randomly assigned to receive either 10 mg rivaroxaban daily (n = 41; median age, 58 years; 85.4% men) or matched placebo (n = 49; median age, 59 years; 79.6% men) for up to 24 months.
The primary combined endpoint was the time to the first occurrence of any portal hypertension-related complication (including new-onset ascites, portal hypertensive gastrointestinal bleeding, and overt hepatic encephalopathy), death, portal vein thrombosis, hepatocellular carcinoma, or liver transplantation.
The safety of rivaroxaban and the incidence of non-portal hypertension-related bleeding events were also assessed. The mean follow-up duration was 10.1 months.
TAKEAWAY:
The primary combined endpoint occurred in 26.8% of patients in the rivaroxaban group vs 46.9% of those in the placebo group, with 1-year survival probabilities of 78.7% vs 54.4% and 2-year survival probabilities of 67.1% vs 43.0%.
The risk of reaching the main endpoint was reduced in the rivaroxaban group (adjusted hazard ratio [HR], 0.418; 95% CI, 0.204-0.858).
In a subgroup analysis, a significant effect of rivaroxaban vs placebo was observed in patients with a Child-Pugh B score of 7 points (n = 55; HR, 0.258; 95% CI, 0.074-0.900).
The rivaroxaban group experienced bleeding events related to non-portal hypertension more frequently than the placebo group (relative risk, 2.56; 95% CI, 1.16-5.67); no differences in first or recurrent portal hypertension-related bleeding or other adverse events were observed between the two groups.
IN PRACTICE:
"Unfortunately, there was no clinical or biochemical parameter able to predict rivaroxaban levels obtained after 10 mg rivaroxaban and, if our data on the beneficial effects of rivaroxaban are confirmed, monitoring of rivaroxaban plasma levels would be required to reduce bleeding risk," the authors of the study wrote.
SOURCE:
This study was led by Ángela Puente, PhD, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain. It was published online on July 19, 2025, in the Journal of Hepatology.
LIMITATIONS:
The trial was underpowered to show statistical significance. The direct effect of rivaroxaban on portal pressure was not assessed. Alcohol consumption was tracked during follow-up visits through direct questioning, without using scales or biochemical markers.
DISCLOSURES:
This study was supported by grants from Instituto de Salud Carlos III and co-funded by the European Union. Support was also received from "Commissioner for Universities and Research from the Department of Economy and Knowledge" of the "Generalitat de Catalunya." Some authors reported receiving grants from Instituto de Salud Carlos III. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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My Son And I Were Turned Away From Ikea's Play Area For A Disturbing Reason. Here's What They Don't Understand.
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My Son And I Were Turned Away From Ikea's Play Area For A Disturbing Reason. Here's What They Don't Understand.

In late June, a few days before Disability Pride Month began, I took my 7-year-old child on an outing to an Ikea store. As I filled out a waiver so he could enter the store's small play area, I noticed I was the only parent present. It turned out that parents typically drop off their children while they shop, but that wasn't an option for me. My son has a rare, severe form of epilepsy called Dravet syndrome, among other medical conditions, and he can't be without a grown-up carrying his seizure rescue medication, as I was. The scary reality is that around one in five children with Dravet syndrome die in childhood because the seizures can be so severe. There is currently no cure. I explained this to a staff member and told her that I'd need to be in the room with my child. She informed me that no parents were allowed into the play area. 'But isn't there a policy for kids with disabilities?' I asked. She told me a service dog could accompany a child, but a parent could not. I stopped signing the form. I said to the staff member, 'That's discrimination against kids with disabilities.' She didn't respond. I hadn't known about the store's play area before this visit, and I had been happy to see that it wasn't a playground ― just a space with toys like a train set and dart board. Since my son had a seizure at an indoor playground a year ago, I'd stopped taking him to them. But now, even this play space was not an option for him. My child and I were both upset. He loves going to Ikea to walk through the showroom and eat in the cafeteria ― a place open enough that it was the only indoor restaurant he ate in during our four years of masking during the COVID-19 pandemic. We have several Ikea furniture items, including bunk beds, a coat/shoe cubby and a toy chest. He helped us build them all. Since his severe seizures began about two years ago, he's had to change his life in significant ways. 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My Son And I Were Turned Away From Ikea's Play Area For A Disturbing Reason. Here's What They Don't Understand.
My Son And I Were Turned Away From Ikea's Play Area For A Disturbing Reason. Here's What They Don't Understand.

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I stopped signing the form. I said to the staff member, 'That's discrimination against kids with disabilities.' She didn't respond. I hadn't known about the store's play area before this visit, and I had been happy to see that it wasn't a playground ― just a space with toys like a train set and dart board. Since my son had a seizure at an indoor playground a year ago, I'd stopped taking him to them. But now, even this play space was not an option for him. My child and I were both upset. He loves going to Ikea to walk through the showroom and eat in the cafeteria ― a place open enough that it was the only indoor restaurant he ate in during our four years of masking during the COVID-19 pandemic. We have several Ikea furniture items, including bunk beds, a coat/shoe cubby and a toy chest. He helped us build them all. Since his severe seizures began about two years ago, he's had to change his life in significant ways. 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time2 days ago

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