Semmler G, Pomej K, Bauer DJM, et al. - This study was undertaken to explore the efficacy and safety of direct oral anticoagulants (DOACs) in patients with advanced liver disease. Researchers retrospectively enrolled liver disease patients receiving DOAC treatment (ACLD:n=104;vascular liver disease:n=29) or vitamin K antagonists/low-molecular-weight heparin (LMWH; ACLD:n=45;vascular:n=13) between 01/2010-09/2020. They recorded invasive procedures and bleeding events. They assessed calibrated anti-Xa peak levels and thrombomodulin-modified thrombin generation assays in a subgroup of 35 DOAC patients. Due to a significant rate of spontaneous bleeding events, anticoagulants including DOACs should be used with caution in patients with advanced liver disease.