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Anticoagulants improve outcomes in cirrhosis-related portal vein thrombosis

Anticoagulant treatment safely and effectively led to partial or complete recanalization of the portal venous system in more than half of patients with cirrhosis, according to recently published study results.

“Portal vein thrombosis (PVT) is a frequent complication in patients with cirrhosis, although it may often remain asymptomatic, at least early after onset,” I. Pettinari, MD, PhD, from the University of Bologna in Italy, and colleagues wrote. “However, PVT is usually associated with some major clinical complications, including worsening of portal hypertension and liver function, and an increased risk of suffering from varices and gastrointestinal bleeding.”

To explore the safety of anticoagulant treatment for PVT, Pettinari and colleagues retrospectively reviewed the data of 81 patients with cirrhosis-related PVT who received anticoagulant therapy and 101 patients who received no anticoagulation.

Forty-six patients who received anticoagulation achieved recanalization after a median of 5 months, 31 of whom achieved complete recanalization and 15 achieved partial recanalization. The rate of recanalization was significantly higher among those who received anticoagulation compared with the untreated group (56.8% vs. 25.7%; P < .0001).

Seventeen treated patients who achieved recanalization experienced recurrence of PVT after discontinuing anticoagulant therapy.

The researchers observed no significant difference in the rate of bleeding complication or any deaths within 30 days of bleeding events between the two groups.

“In agreement with the current literature, the present study has shown that individualized anticoagulant therapy in cirrhotic patients with PVT is safe as bleeding events do not occur at higher rates than in untreated patients, and the hemorrhagic complications are seldom ascribed to the anticoagulant therapy itself,” the researchers wrote.

Treatment with anticoagulant therapy demonstrated a significantly higher cumulative survival rate compared with the untreated group (P = .01). Additionally, more untreated patients required liver transplantation following PVT diagnosis (17.8% vs. 7.4%; P = .0476).

“Portal vein thrombosis is a frequent complication in liver cirrhosis but its natural history as well as therapeutic management have not yet been clearly addressed by either international guidelines or consensus conferences,” Pettinari and colleagues concluded. “The present study confirmed that recanalization of PVT may occur spontaneously, but it is significantly favored by anticoagulant treatment.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.