68 year old male with history of Hepatitis C from history of IVDU, hx of etoh and substance dependence but in remission since 2010. Hx of leiomyosarcoma in 2014 with PE/DVT now on eliquis, PDV with chronic LE ulcer, neutropenia (usually 1200-1300 ish). I have tried to get him to GI ever since I’ve known him and he’s had 1 appointment then no-showed. I would like to get his hep c treated. I looked at the AASLD/IDSA treatment algo and calculated his FIB-4 which was 6.01 so according to that he was presumed cirrhosis, I queried him for any sx of decompensated cirrhosis which he denied. I ordered liver ultrasound with elastography.
(1) With a fib-4 score of > 3.25, can I document cirrhosis?
(2) Cirrhosis falls under the ineligible category for the AASLD/IDSA but then it says “Cirrhosis (see simplified treatment for treatment-naive adults with compensated cirrhosis)” so can I treat it?
(3) I have attached the last labs from 5/2021. If I can treat it, do I need to check genotypes?
(4) There is a caveat regarding warfarin; is there any implication regarding DOACs?