✳️ The Challenge of Anticoagulation in Liver Cirrhosis
▶️ A systematic review that included 11 studies determined there was a significantly increased risk of pulmonary embolism and DVT) in patients with cirrhosis compared with controls
▶️ patients with cirrhosis are at a higher risk of developing DVT than the general population - An even higher risk is reported in patients with cirrhosis due to non-alcoholic steatohepatitis
▶️ patients with cirrhosis who suffer from concomitant AF have higher in-hospital mortality rates compared to those who do not. DOACs prescribed in sub-therapeutic doses,are effient, in terms of both bleeding and thrombotic complications
▶️ patients with decompensated cirrhosis experiencing some level of chronic kidney disease (CKD) in a percentage of > 45% in a recent study ,Regarding CKD, recent guidelines regarding the management of atrial fibrillation encourage the use of DOACs even in patients with a glomerular filtration rate (GFR) of 15 to 30 mL/min, in a reduced dose
▶️ AC DOACs is safe and effective in patients with cirrhosis. AC may in future be regarded as a therapeutic regimen for patients with cirrhosis, preventing decompensation and increasing survival.
▶️ The European Association for the Study of the Liver (EASL) recommends that patients with cirrhosis who are at risk of VTE receive LMWH
▶️ Each DOAC has a different hepatic excretion rate (, 65 percent for rivaroxaban, , and 75 percent for apixaban), but warfarin has a 100 percent hepatic excretion rate, implying more predictable pharmacokinetics for DOACs in liver cirrhosis
▶️ Anticoagulant therapy should not be used in patients with Child–Pugh Class C, which has a 1-year survival rate of less than 50% without a liver transplant.
▶️ An INR greater than 2.0 was previously thought to protect against VTE; however, more recent observations have disproved this theory.-It only evaluates the activity of several procoagulant components (FI, FII, FV, FVII, and FX), and not the activity of anticoagulant proteins C and S; therefore, INR does not appear to be a viable tool for monitoring hemostasis in cirrhotic patients.
▶️ the use of rivaroxaban, should be generally avoided in Child Pugh class B and C]. rivaroxaban showed higher rates of hepatotoxicity than other DOAC]. Apixaban owns a more favorable profile because its risk of drug-induced liver injury (DILI) is lower
▶️ A systematic review that included 11 studies determined there was a significantly increased risk of pulmonary embolism and DVT) in patients with cirrhosis compared with controls
▶️ patients with cirrhosis are at a higher risk of developing DVT than the general population - An even higher risk is reported in patients with cirrhosis due to non-alcoholic steatohepatitis
▶️ patients with cirrhosis who suffer from concomitant AF have higher in-hospital mortality rates compared to those who do not. DOACs prescribed in sub-therapeutic doses,are effient, in terms of both bleeding and thrombotic complications
▶️ patients with decompensated cirrhosis experiencing some level of chronic kidney disease (CKD) in a percentage of > 45% in a recent study ,Regarding CKD, recent guidelines regarding the management of atrial fibrillation encourage the use of DOACs even in patients with a glomerular filtration rate (GFR) of 15 to 30 mL/min, in a reduced dose
▶️ AC DOACs is safe and effective in patients with cirrhosis. AC may in future be regarded as a therapeutic regimen for patients with cirrhosis, preventing decompensation and increasing survival.
▶️ The European Association for the Study of the Liver (EASL) recommends that patients with cirrhosis who are at risk of VTE receive LMWH
▶️ Each DOAC has a different hepatic excretion rate (, 65 percent for rivaroxaban, , and 75 percent for apixaban), but warfarin has a 100 percent hepatic excretion rate, implying more predictable pharmacokinetics for DOACs in liver cirrhosis
▶️ Anticoagulant therapy should not be used in patients with Child–Pugh Class C, which has a 1-year survival rate of less than 50% without a liver transplant.
▶️ An INR greater than 2.0 was previously thought to protect against VTE; however, more recent observations have disproved this theory.-It only evaluates the activity of several procoagulant components (FI, FII, FV, FVII, and FX), and not the activity of anticoagulant proteins C and S; therefore, INR does not appear to be a viable tool for monitoring hemostasis in cirrhotic patients.
▶️ the use of rivaroxaban, should be generally avoided in Child Pugh class B and C]. rivaroxaban showed higher rates of hepatotoxicity than other DOAC]. Apixaban owns a more favorable profile because its risk of drug-induced liver injury (DILI) is lower
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Steatosis.pdf
6.8 MB
Is liver steatosis a disease or the emperor’s new clothes?
EASL jan 2026
AGA_Clinical_Practice_Update_on_Inpatient_Management_of_Adults_With.pdf
3.6 MB
AGA Clinical Practice Update on Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review
AGA February 2026
The Optimal Timing and Effectiveness of a Transparent Cap in the Endoscopic Removal of Bony Foreign Bodies From the Esophagus.
PDF
ACG jan 2026
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✳️ Hyperammonemia predicts the development of liver-related events in a prospective cohort of stable cirrhosis patients and the external validation of the AMMON-OHE score
1. Hyperammonemia predicts liver complications
- Patients with ammonia levels ≥ upper limit of normal (AMN ≥ULN) had a 4.92-fold higher risk of developing liver-related events (LRE) within 1 year
- 64.5% of patients with elevated ammonia developed complications vs. only 10% with normal levels
2. Predictive power across cirrhosis stages
- Ammonia predicted complications in both compensated and decompensated cirrhosis
- Patients with compensated cirrhosis and high ammonia had similar risk to decompensated patients with normal ammonia (~25%)
3. Superior to traditional scoring systems
- Ammonia alone had better predictive accuracy (AUROC 0.892) than MELD score (0.783) and comparable to Child-Pugh score (0.885)
4. Clinical implications
- Ammonia predicts multiple complications beyond hepatic encephalopathy: ascites, infections, variceal bleeding
- Not affected by kidney disease or muscle loss (sarcopenia)
- Can be measured with a simple blood test in outpatient settings
Open Access
1. Hyperammonemia predicts liver complications
- Patients with ammonia levels ≥ upper limit of normal (AMN ≥ULN) had a 4.92-fold higher risk of developing liver-related events (LRE) within 1 year
- 64.5% of patients with elevated ammonia developed complications vs. only 10% with normal levels
2. Predictive power across cirrhosis stages
- Ammonia predicted complications in both compensated and decompensated cirrhosis
- Patients with compensated cirrhosis and high ammonia had similar risk to decompensated patients with normal ammonia (~25%)
3. Superior to traditional scoring systems
- Ammonia alone had better predictive accuracy (AUROC 0.892) than MELD score (0.783) and comparable to Child-Pugh score (0.885)
4. Clinical implications
- Ammonia predicts multiple complications beyond hepatic encephalopathy: ascites, infections, variceal bleeding
- Not affected by kidney disease or muscle loss (sarcopenia)
- Can be measured with a simple blood test in outpatient settings
Open Access
AASLD February 2026
✳️ Rifaximin reduces rehospitalization risk in patients with cirrhosis and overt hepatic encephalopathy
▶️ Conclusion: Rifaximin reduces the risk of readmissions for hepatic encephalopathy. One of the clearest cases where RCT-based effect sizes are reproducible in trials.
Open Access
▶️ Conclusion: Rifaximin reduces the risk of readmissions for hepatic encephalopathy. One of the clearest cases where RCT-based effect sizes are reproducible in trials.
Open Access
AASLD February 2026
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file.pdf
4.6 MB
AASLD AST Practice Guideline on adult liver transplantation: Diagnosis and post-transplant management of non-graft-related complications
AASLD 17 December 2025
✳️ The dosage of diuretics for mild ascites should not be adjusted to alternate days or administered only two to three times per week, but rather should be given daily with careful titration and monitoring as per current guidelines.
▶️ Current guidelines recommend daily administration of diuretics (spironolactone, with or without furosemide) for the management of mild to moderate ascites, with dose titration based on clinical response, weight, and laboratory monitoring, and do not support alternate-day or less frequent dosing regimen.
▶️ Spironolactone's long half-life allows for once-daily dosing, but its pharmacodynamics require several days to reach steady state, and dose adjustments should be made cautiously every 72 hours, not by skipping days or reducing frequency to two or three times per week.
▶️ After ascites is controlled, diuretics should be tapered to the lowest effective daily dose to minimize adverse effects, but intermittent or non-daily dosing is not recommended in guidelines or expert reviews for maintenance, even in mild cases.
▶️ Current guidelines recommend daily administration of diuretics (spironolactone, with or without furosemide) for the management of mild to moderate ascites, with dose titration based on clinical response, weight, and laboratory monitoring, and do not support alternate-day or less frequent dosing regimen.
▶️ Spironolactone's long half-life allows for once-daily dosing, but its pharmacodynamics require several days to reach steady state, and dose adjustments should be made cautiously every 72 hours, not by skipping days or reducing frequency to two or three times per week.
▶️ After ascites is controlled, diuretics should be tapered to the lowest effective daily dose to minimize adverse effects, but intermittent or non-daily dosing is not recommended in guidelines or expert reviews for maintenance, even in mild cases.
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The Saline-Immersion/Irrigation TEchnique for Endoscopic Submucosal Dissection of Colorectal Lesions: Outcomes From a Large Western Cohort
Open Access
Conclusion ; Saline-Immersion/Irrigation Technique (SITE) + Pocket-Creation Method for colorectal ESD (n=181) showed:
✅ En bloc resection
🎯 R0 92.3% | Curative 90.6%
⏱️ Median time 120 min
⚠️ AEs only 4.4%
▶️ 93% done under conscious sedation
Open Access
Conclusion ; Saline-Immersion/Irrigation Technique (SITE) + Pocket-Creation Method for colorectal ESD (n=181) showed:
✅ En bloc resection
🎯 R0 92.3% | Curative 90.6%
⏱️ Median time 120 min
⚠️ AEs only 4.4%
▶️ 93% done under conscious sedation
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✳️ Randomized clinical trial of infliximab versus vedolizumab for immune checkpoint inhibitor related colitis.
▶️ Conclusion: Our results suggest that both agents are equally effective at controlling symptoms within two weeks of the first infusion, with a small number of patients receiving either having recurrent disease. The two drugs have a comparable safety profile with primarily mild AEs occurring. Our preliminary findings suggest that both drugs can be used effectively in first-line treatment of IMDC, but further data is necessary to ascertain long-term outcomes.
Open Access
▶️ Conclusion: Our results suggest that both agents are equally effective at controlling symptoms within two weeks of the first infusion, with a small number of patients receiving either having recurrent disease. The two drugs have a comparable safety profile with primarily mild AEs occurring. Our preliminary findings suggest that both drugs can be used effectively in first-line treatment of IMDC, but further data is necessary to ascertain long-term outcomes.
Open Access
Management of Hepatitis B 2026 ANNALS of Hepatology.pdf
968.9 KB
ALEH position statement on the management of hepatitis B virus
infection.
infection.
Annals Of Hepatology Jan.2026
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