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 22 October 2017

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News

Anticoagulants in patients with cirrhosis and portal vein thrombosis

A study in the most recent issue of Gastroenterology examines the effects of anticoagulants in patients with cirrhosis and portal vein thrombosis.

News image

Liver cirrhosis is complicated by bleeding from portal hypertension but also by portal vein thrombosis.

Portal vein thrombosis occurs in approximately 20% to 50% of patients with cirrhosis, and is a warning sign for poor outcome.

It is a challenge to treat patients with cirrhosis using anticoagulants, because of the perception that the coexistent coagulopathy could promote bleeding.

Professor Francesco Violi and colleagues from Italy performed a systematic review and meta-analysis to determine the effects of anticoagulant therapy in patients with cirrhosis and portal vein thrombosis.

The team searched the PubMed, ISI Web of Science, SCOPUS, and Cochrane databases through 2017, for studies that assessed the effect of anticoagulant therapy vs no treatment in patients with cirrhosis and portal vein thrombosis.

53% treated with anticoagulants had complete portal vein thrombosis recanalization
Gastroenterology

The researchers performed a meta-analysis to estimate the effect of anticoagulant treatment vs no therapy on recanalization and progression of portal vein thrombosis in patients with cirrhosis.

The team also assessed variceal and nonvariceal bleeding.

The researchers analyzed data from 8 studies, comprising 353 patients, that assessed the effects of anticoagulant therapy in patients with cirrhosis and portal vein thrombosis.

These studies reported rates of complete and partial recanalization.

The team observed a significantly higher proportion of patients treated with anticoagulants underwent portal vein thrombosis recanalization than patients who did not receive anticoagulants.

From 6 studies, 53% of patients treated with anticoagulants vs 33% of patients who did not receive anticoagulants had complete portal vein thrombosis recanalization.

The research team observed that from 6 studies, portal vein thrombosis progressed in 9% of patients treated with anticoagulants vs 33% of patients who did not receive these drugs.

The team identified 6 studies reported rates of any bleeding.

There was no difference in the proportions of patients with major or minor bleeding between groups that did vs did not receive anticoagulants.

The researchers identified 4 studies that reported rates of spontaneous variceal bleeding, which occurred in a significantly lower proportion of patients who received anticoagulants vs those who did not.

Professor Violi's team comments, "Based on a systematic review and meta-analysis, patients with cirrhosis and portal vein thrombosis who receive anticoagulant therapy have increased recanalization and reduced progression of thrombosis, compared with patients who do not receive anticoagulants, with no excess of major and minor bleedings and less incidence of variceal bleeding."

Gastroenterol 2017: 153(2): 480–487.e1
09 August 2017

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