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Liver injury with direct-acting anticoagulants: has the fog cleared?
  1. Emanuel Raschi,
  2. Fabrizio De Ponti
  1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  1. Correspondence to Professor Fabrizio De Ponti, Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Via Irnerio, 48, I-40126 Bologna BO, Italy; fabrizio.deponti{at}

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To the Editor The timely retrospective US cohort study by Alonso et al 1 assessed the risk of hospitalisations for liver injury after initiation of oral anticoagulation in patients with non-valvular atrial fibrillation, an unresolved safety issue so far.

This study has key merits. First, it demonstrates the importance of conducting analytical research following safety signals emerging from spontaneous reporting systems2 to confirm or refute the drug-related hypothesis; this allows actual risk assessment and avoids unnecessary alarm, sometimes generated …

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  • Contributors ER conceived the study and drafted the first version, and FDP provided substantial contribution to the first version. All authors approved the final version of the letter.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.