Internal and Emergency Medicine

, Volume 13, Issue 5, pp 775–790 | Cite as

Direct-acting antiviral drugs for chronic hepatitis C and risk of major vascular events: a systematic review

  • Eleonora Tamborini Permunian
  • Lorenzo Gervaso
  • Victor Gerdes
  • Lorenzo Moja
  • Luigina GuastiEmail author
  • Alessandro Squizzato


Direct-acting antiviral drugs (DAAs) were recently approved for treating hepatitis C virus-related chronic hepatitis. As advanced chronic liver disease may predispose patients to thrombotic events, it is still uncertain whether DAAs may influence the actual risk of major arterial and venous thrombotic events. We performed a systematic review to assess the incidence of major vascular events in patients receiving DAAs for HCV chronic hepatitis during phase-III randomized controlled trials (RCTs). Two reviewers identified studies through Pubmed database until October 2015. Reporting and incidence of any vascular events were compared with reporting and incidence of major bleeding, anemia (a prespecified safety outcome) and headache (a common non-prespecified safety outcome). 33 RCTs, encompassing 14,764 patients, were included. Only 13 (39%) and 4 (12%) RCTs provide data on any arterial or venous events, respectively. Occurrence of anemia and headache is reported in all studies. Crude unweighted rate of major arterial events is 0.16% (95% CI 0.10–0.24) of the total included population and 0.47% in those 13 RCTs reporting data. Crude unweighted rate of major venous events is 0.03% of the total included population (95% CI 0.01–0.08) and 0.22% in those four RCTs reporting data. Crude unweighted rate of major bleeding is 0.07% (95% CI 0.03–0.1). Incidence of thrombotic events in HCV patients receiving DAAs may be low, but an incorrect estimation cannot be excluded.


Chronic hepatitis Direct-acting antiviral drugs Myocardial infarction Underreporting Venous thromboembolism 


Author contributions

ETP performed data collection and analysis, manuscript writing and final approval. AS was involved in study design, data interpretation, manuscript writing and final approval. LG performed data collection. VEAG, LM and LG performed data interpretation, manuscript editing and final approval.

Compliance with ethical standards

Conflict of interest


Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent


Supplementary material

11739_2018_1828_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 33 kb)


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Eleonora Tamborini Permunian
    • 1
  • Lorenzo Gervaso
    • 2
  • Victor Gerdes
    • 3
  • Lorenzo Moja
    • 4
  • Luigina Guasti
    • 1
    • 5
    Email author
  • Alessandro Squizzato
    • 1
  1. 1.Department of Medicine and Surgery, Research Centre on Thromboembolic Disorders and Antithrombotic TherapiesUniversity of InsubriaVareseItaly
  2. 2.Oncology Unit, IRCCS Fondazione Salvatore MaugeriUniversity of PaviaPaviaItaly
  3. 3.Department of Internal MedicineMC SlotervaartAmsterdamThe Netherlands
  4. 4.Unit of Clinical EpidemiologyI.R.C.C.S. Orthopedic Institute GaleazziMilanItaly
  5. 5.U.O. Medicina Interna 1ASST SettelaghiVareseItaly

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