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Anticoagulant therapy can effectively treat portal vein thrombosis

Treatment with anticoagulants in patients with cirrhosis and portal vein thrombosis led to partial or complete recanalization in the majority of participants in a recent study.

Researchers evaluated 55 patients with cirrhosis and portal vein thrombosis (PVT) who received anticoagulant therapy for acute or subacute thrombosis (31 patients) or progression of previous PVT (24 patients). Anticoagulants used included low-molecular-weight heparin (LMWH) in 47 patients and vitamin K antagonists (VKA) in eight patients. Therapy continued for a median of 6.8 months. Ultrasound, angio-computed tomography and/or angio-magnetic resonance imaging were used to establish recanalization, with a median follow-up of 19 months.

A median delay of 9 days occurred between the initial imaging indicating thrombosis or its progression and therapy initiation. Twenty-one patients using LMWH were transitioned to VKA after a median of 17 days. Treatment cessation before the end of the study occurred in 27 patients after a median of 6.3 months, including two cases before 3 months because of bleeding.

Recanalization occurred in 33 patients, including complete recanalization in 25 of them. Following cessation of anticoagulant treatment, rethrombosis occurred in 38.5% of patients who achieved complete recanalization. Early therapy initiation was significantly associated with recanalization (P=.044).

Adverse events affected 17 patients, including six incidents of variceal bleeding, eight of new or worsening ascites, five cases of hepatic encephalopathy and two hepatocellular carcinomas. Participants who achieved recanalization were less prone to liver-related events including hypertension-related bleeding, ascites and hepatic encephalopathy during follow-up, but the trend was not statistically significant (P=.1). A platelet count below 50 x 109/L was significantly associated with a higher risk for bleeding complications (P=.018).

“We propose that anticoagulation therapy is a relatively safe and effective treatment for patients with cirrhosis and PVT,” the researchers concluded. “In patients achieving complete recanalization, the discontinuation of anticoagulation therapy is associated with a high risk of recurrent thrombosis. This observation indicates that anticoagulation should be maintained throughout life to maintain recanalization. However … the risk/benefit of anticoagulation treatment should be deliberated when dealing with patients with cirrhosis and PVT.”