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

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Abstract

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.

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Authors and Affiliations

  1. Department of Medicine and Surgery, Research Centre on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy

    Eleonora Tamborini Permunian, Luigina Guasti & Alessandro Squizzato

  2. Oncology Unit, IRCCS Fondazione Salvatore Maugeri, University of Pavia, Pavia, Italy

    Lorenzo Gervaso

  3. Department of Internal Medicine, MC Slotervaart, Amsterdam, The Netherlands

    Victor Gerdes

  4. Unit of Clinical Epidemiology, I.R.C.C.S. Orthopedic Institute Galeazzi, Milan, Italy

    Lorenzo Moja

  5. U.O. Medicina Interna 1, ASST Settelaghi, Viale Borri, 57, 21100, Varese, Italy

    Luigina Guasti

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  1. Eleonora Tamborini Permunian
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  2. Lorenzo Gervaso
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  3. Victor Gerdes
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  4. Lorenzo Moja
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  5. Luigina Guasti
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  6. Alessandro Squizzato
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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.

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Correspondence to Luigina Guasti.

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Tamborini Permunian, E., Gervaso, L., Gerdes, V. et al. Direct-acting antiviral drugs for chronic hepatitis C and risk of major vascular events: a systematic review. Intern Emerg Med 13, 775–790 (2018). https://doi.org/10.1007/s11739-018-1828-8

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