Drug-induced liver injury with oral anticoagulants: a threat or not?

Drug-induced liver injury (DILI) can develop with the use of virtually any drug. The growing list of medications or herbal products reported in association with DILI presently includes >1000 compounds, but the annual incidence of DILI has been estimated to only 1–1.5 per 1000–10 000 exposed persons.1 Nonetheless, DILI accounts for ~10% of all acute hepatitis cases and is the most common cause of acute liver failure (ALF).1 2 Drugs (or their metabolites) can affect the liver in a dose-dependent, predictable fashion (eg, acetaminophen) or via unpredictable immune-mediated (eg, phenytoin) or metabolic (eg, isoniazid) idiosyncratic reactions.2 While immune-mediated response typically occurs with short latency of 1–4 weeks, metabolic idiosyncrasies may occur ≤1 year later.2 Generally, adults have a higher risk of DILI than children. Age, female sex, alcohol abuse, malnutrition, pre-existent liver disease and the P-450 gene mutations are the main risk factors for DILI.
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research