WANG Yong, YANG Yang, DING Xiaoliang, XIE Cheng
OBJECTIVE To analyze and explore the characteristics of drug-induced liver injury (DILI) induced by oral anticoagulants (OACs), and provide references for clinical safety of drug use. METHODS Case reports of DILI caused by OACs published in Pubmed, Embase, CNKI, Wanfang, and VIP databases up to July 2025 were retrieved. Key information, and conducted a systematic literature review and descriptive analysis based on the case reports were collected. RESULTS A total of 68 cases from 45 articles were identified, including 34 males (50.0%) and 33 females (48.5%). The patients were aged from 20 to 91 years with an average age of (67.2±16.0) years, and 48 patients (70.6%) were 60 years or older. The OACs involved included warfarin in 13 cases (19.1%), dabigatran in 6 cases (8.8%), apixaban in 4 cases (5.9%) and rivaroxaban in 45 cases (66.2%). DILI occurred from 1 to 586 days with an average of (56.1±99.8) days after treatment, and 41 cases (60.3%) within 5 to 90 days. The types of DILI were mainly hepatocellular injury type (33 cases, 48.5%), followed by cholestatic type (17 cases, 25.0%) and mixed type (11 cases, 16.2%). Most cases were of grade 1 (18 cases, 26.5%) and grade 2 (26 cases, 38.2%) severity. The main clinical manifestations were jaundice (31 cases, 45.6%), nausea (17 cases, 25.0%), fatigue (10 cases, 14.7%), vomiting (8 cases, 11.8%) and pruritus (8 cases, 11.8%). After 3 to 365 with an average of (49.6±80.5) days of treatment including drug withdrawal, liver protection, administration of specific antagonists and adjustment of anticoagulant therapy regimens, 63 patients (92.6%) improved and 5 patients (7.4%) died. CONCLUSIONS Various OACs except edoxaban can cause DILI. DILI induced by OACs mostly occurs in patients aged 60 years and older, and is mainly characterized by mild-to-moderate hepatocellular injury. Clinicians should pay close attention to the liver function and the presence of symptoms such as jaundice, nausea, and fatigue within 90 days after medication. Once DILI is suspected, the drug should be discontinued promptly and symptomatic treatment should be given.