Schütz K, et al. (2006). Taraxacum — A review onits phytochemical and pharmacological profile. DOI: Produktet indeholder bl.a. marietidsel, artiskok, gurkemeje, cholin og sort peber. Artiskok understøtter lever-galde-funktionen.

Prospective studies and RCTs evaluating the efficacy and safety of DOACs in large subgroups of patients with compensated (CTP A) and decompensated (CTP B) cirrhosis are needed to establish appropriate dose adaptation rules based on bleeding/thromboembolic outcomes, aminotransferases/bilirubin cut-offs for DOACs use, risk factors for serious complications such as bleeding and, finally, which DOACs are more effective and safer in these patients.

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Active Liver er et kosttilskud som bidrager til vedligeholdelse af en normal leverfunktion. Tabletterne er specielt velegnet til dig, som lever et ernæringsmæssigt usundt liv med for meget fedt. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016;65:589–600.

Reducing liver fat takes away the root cause of NAFLD. By doing this, you reduce the strain on your liver and give it a chance to repair itself. Research shows all 3 of these things can slow, stop and even reverse NAFLD. Whatever your weight, eating healthily and being more physically active can each help reduce liver fat and improve NAFLD. And for most people these are the best ways to lose weight, if you need to. Ribeiro de Avilar, C, et al. (2017).Effect of silymarin on biochemical indicators in patients with liver disease:Systematic review with meta-analysis. In cirrhotic patients, pro-hemorrhagic and prothrombotic drivers co-exist. Pro-hemorrhagic conditions include: (a) reduced plasma levels of coagulation factors synthesized by the liver [fibrinogen, factor (F)II, FV, FVII, FIX, FX, FXI, and FXII] reflected by prolonged PT and activated partial thromboplastin time (aPTT) (b) thrombocytopenia due to splenic sequestration and reduced thrombopoietin synthesis and (c) increased fibrinolysis secondary to elevated levels of tissue plasminogen activator, reduced levels of plasmin inhibitor and thrombin-activatable fibrinolysis inhibitor [ 17]. Conversely, pro-thrombotic conditions include: (a) decreased endogenous anticoagulants synthesized by the liver: protein C, protein S and antithrombin (AT) (b) increased pro-coagulant endothelial-derived FVIII (c) increased platelet aggregation due to increased endothelial-derived von Willebrand factor (vWF) and reduced ADAMTS13, a natural inhibitor of vWF activity (d) reduced hepatic synthesis of plasminogen causing hypo-fibrinolysis [ 17]. National Center for Complementary and Integrative Health: “ ‘Detoxes’ and ‘Cleanses,’ ” “Milk Thistle.”

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Some studies say compounds from milk thistle have helped ease the symptoms of certain types of liver disease. But no research shows that it treats the disease itself. Aim to do at least 2½ hours of physical activity every week that gets you a bit out of breath. Brisk walking, team sports, swimming and dancing all count. You can break it down into smaller bouts of 10 minutes at a time. Cai J, Zhang XJ, Ji YX, Zhang P, She ZG, Li H. Nonalcoholic fatty liver disease pandemic fuels the upsurge in cardiovascular diseases. Circ Res. 2020;126:679–704. Turco L, Schepis F, Villa E. The role of anticoagulation in treating portal hypertension. Curr Hepatol Rep. 2018;17:200–8. Proietti M, Marzona I, Vannini T, Colacioppo P, Tettamanti M, Foresta A, et al. Impact of liver disease on oral anticoagulant prescription and major adverse events in patients with atrial fibrillation. Eur Heart J Cardiovasc Pharmacother. 2020. https://doi.org/10.1093/ehjcvp/pvaa015 (Epub ahead of print).

DOACs pharmacokinetic properties (in particular liver metabolism of anti-Xa inhibitors) have raised concerns about potential drug induced liver injury (DILI) (i.e. transaminases > 3 × ULN with total bilirubin > 2 × ULN). Apart from Ximelagatran, an oral direct thrombin inhibitor which was rapidly withdrawn from the market in 2006 owing to a high risk of hepatoxicity, DOACs have generally demonstrated an adequate liver safety profile [ 5]. A recent study, using data from a large healthcare utilization database in the United States, has shown a lower rate of hospitalizations for DILI in patients on DOACs as compared to those on warfarin (5 vs. 9 per 1000 person-years) among a cohort of 113,717 patients with NVAF receiving a first-time oral anticoagulant prescription (50% warfarin and 50% DOACs). Among DOACs, dabigatran had the lowest relative risk of hospitalization owing to DILI [ 113]. History of hepato-biliary disease, alcoholism, kidney disease, heart failure, anemia and cancer are risk factors for hospitalization owing to DILI [ 113]. A 2017 analysis of studies found that silymarin slightly reduced certain liver enzymes, markers of liver damage, in people with liver disease. More research is still needed to know how well milk thistle might work.

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Cardiologists, hepato-gastroenterologists and hematologists should collaborate to optimize anticoagulant treatment in patients with CLD: no evidence is available on which DOAC has the best efficacy and safety profile in such patients. In clinical practice the choice between different DOACs should consider their pharmacodynamic properties, patient characteristic, data from RCTs and prospective cohort studies on general population and from accumulating studies on liver disease patients.

A meta-analysis of 29 phase III RCTs has shown that all DOACs as a class, and also the individual drugs, do not increase the risk of DILI as compared to standard anticoagulation (VKA/LMWH) or placebo [ 110]. A recent post-hoc analysis of a prospective large multicentre study on AF outpatients treated with either VKAs ( n.1297) or DOACs ( n.1033) has shown that advanced fibrosis, assessed non-invasively by the validated FIB-4 score > 3.25, was significantly associated with major bleeding events in AF patients treated with VKAs but not in those on DOACs [ 83]. Hospitalized patients with cirrhosis have a 0.5–6.3% incidence of newly-diagnosed PE or DVT, similar to those without liver disease [ 29]. Validated risk stratification scores that predict VTE within hospitalized patients, also appear to accurately predict VTE among hospitalized patients with CLD [ 30]. Interestingly, a recent meta-analysis has shown that the risk of all VTE events was higher in patients with cirrhosis than in controls with an odds ratio (OR) of 1.7 [ 15]. Moreover, patients with cirrhosis and VTE may have increased mortality over 30 days as compared to those with VTE without cirrhosis [ 31, 32]. Nevertheless, prophylactic anticoagulation for VTE in hospitalized cirrhotics is significantly lower than in non-cirrhotics [ 33]. Wang CL, Wu VC, Kuo CF, Chu PH, Tseng HJ, Wen MS, Chang SH. Efficacy and safety of non-vitamin k antagonist oral anticoagulants in atrial fibrillation patients with impaired liver function: a retrospective cohort study. J Am Heart Assoc. 2018;7:e009263.

Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and meta-analysis. Gastroenterology. 2017;153:480–7.