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Anticoagulants reduce portal vein thrombosis progression in cirrhosis

Patients with cirrhosis and portal vein thrombosis who received anticoagulant therapy had increased recanalization, reduced progression of thrombosis and a lower incidence of variceal bleeding compared with patients who did not receive anticoagulants, according to a recent systematic review and meta-analysis.

“Treatment of patients with cirrhosis and [portal vein thrombosis] is challenging because, compared with other clinical settings, in [liver cirrhosis] carries per se a gastrointestinal-related bleeding risk, which could minimize the potentially beneficial effect of anticoagulants,” Lorenzo Loffredo, MD, from the Sapienza University, Rome, and colleagues wrote. “The present study shows, however, that whatever the anticoagulant, a beneficial clinical efficacy was detected.”

The meta-analysis included eight studies totaling 353 patients. All studies compared the effect of anticoagulant therapy on portal vein thrombosis with no treatment, and anticoagulant treatment consisted of low-molecular-weight heparin or vitamin K antagonists and lasted approximately 6 months.

Across all studies, the rate of portal vein thrombosis recanalization was significantly higher in patients treated with anticoagulants compared with untreated patients (71% vs. 42%; OR = 4.8; 95% CI, 2.7-8.7).

Data from six studies showed a complete recanalization rate of 53% for treated patients compared with 33% in untreated patients (OR = 3.4; 95% CI, 1.5-7.4). In another set of six studies, portal vein thrombosis progression was 9% in treated patients vs. 33% in untreated patients (OR = 0.141; 95% CI, 0.06-0.31).

Findings from six studies showed that 11% of both treated and untreated patients had major or minor bleeding. In four studies, however, treated patients had a 2% rate of variceal bleedings compared with 12% of the untreated patients (OR = 0.232; 95% CI, 0.06-0.94).

There was no heterogeneity observed in any of the compared studies, although there was a statistically significant publication bias found among the set of six studies that compared the rates of complete portal vein thrombosis recanalization (P = .004).

Subgroup analysis showed that low-molecular-weight heparin treatment was effective for complete recanalization (OR = 8.386; 95% CI, 3.287-21.393) and progression of portal vein thrombosis (OR = 0.062; 95% CI, 0.04-0.097), and correlated with a lower rate of variceal bleeding (OR = 0.103; 95% CI, 0.04-0.264).

Compared with low-molecular-weight heparin treatment (OR = 0.338; 95% CI, 0.238-0.479) and untreated patients (OR = 5.446; 95% CI, 3.089-9.96), warfarin was effective for reducing progression of portal vein thrombosis; however, “this result should be interpreted with caution, as most studies on warfarin were retrospective, and no data on anticoagulation quality were available,” the researchers wrote. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.