Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis of observational studies

Qi, Xingshun; Stefano, Valerio De; Li, Hongyu; Dai, Junna; Guo, Xiaozhong; Fan, Daiming

doi:10.1016/j.ejim.2014.12.002

Cited by 136 publications

(119 citation statements)

References 59 publications

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“…The presence of PVT, especially complete occlusion, negatively influenced the 1-year survival of LT recipients, which suggests the necessity of a prior recanalization of thrombosed portal vein by anticoagulation or other pharmacological/ interventional procedures [50]. However, the association of PVT with the in-hospital, 1-month, and 5-year survival remained unclear due to a relatively small number of included studies.…”

Section: Discussionmentioning

confidence: 94%

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Dai

Jia

et al. 2015

JGLD

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Background & Aims: Portal vein thrombosis (PVT) increases the technical complexity of liver transplantation (LT). This systematic review and meta-analysis aim to analyze the association of pre-LT PVT with the overall survival after LT.Methods. PubMed, EMBASE, and Cochrane library databases were used to search for papers related to the association between pre-LT PVT and survival of LT recipients. The differences in the survival rates between the LT recipients with and without pre-LT PVT were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).Results. Twenty-seven papers were included. Overall meta-analysis showed that the total LT recipients with pre-LT PVT had a significantly lower 1-year survival rate than those without pre-LT PVT (OR=0.733, 95%CI=0.621-0.865; P=0.0002). But no statistically significant difference was observed in the in-hospital (OR=0.713, 95%CI=0.343-1.482; P=0.365), 1-month (OR=0.679, 95%CI=0.345-1.333; P=0.261), or 5-year survival rate (OR=0.788, 95%CI=0.587-1.058; P=0.113). Additionally, the 1-year survival rate was significantly lower in the LT recipients with complete PVT than in those without PVT (OR=0.503, 95%CI=0.295-0.858; P=0.012). However, no statistically significant difference in the 1-year survival rate between them was observed in the meta-analysis of high-quality studies (OR=0.899, 95%CI=0.657-1.230; P=0.505) or that of studies in which LT was performed after 2000 (OR=0.783, 95%CI=0.566-1.083; P=0.140).Conclusion. Pre-LT PVT, especially complete PVT, decreased the 1-year survival rate after LT. However, the detrimental effect of pre-LT PVT on the survival of LT recipients became inconclusive in high-quality studies. Additionally, further well-designed cohort studies should validate the association in patients undergoing LT during the latter years.

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Section: Discussionmentioning

confidence: 94%

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Dai

Jia

et al. 2015

JGLD

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“…Using this strategy, the authors did not report any case of bleeding post-procedure [36]. Overall, as demonstrated in a meta-analysis published by Qi et al, the bleeding complication rate is relatively low when screening for EV and prophylaxis against EVB are applied adequately in patients with cirrhosis undergoing anticoagulation for PVT [7]. In this metaanalysis, the pooled rate of bleeding complications related to anticoagulation was 3.3 % (95 %CI 1.1-6.7 %), which is comparable to the bleeding complication rate seen in noncirrhotic patients receiving anticoagulation [42].…”

Section: Prevention Of Bleeding Complications In Patients Receiving Amentioning

confidence: 64%

“…According to a published meta-analysis including 16 studies, the pooled rate of PV recanalization after 6 months of anticoagulation therapy in cirrhotic patients was 66 %, complete PV recanalization being observed in approximately half of these patients [7]. However, in the study published by Amitrano et al, prolongation of anticoagulation therapy in patients with partial PV recanalization beyond 6 months was associated with improved rate of complete PV recanalization: 86 % of these patients could achieve complete PV recanalization after a median anticoagulation duration of 11 (7-17) months [36].…”

Section: Optimal Duration Of Anticoagulation Therapymentioning

confidence: 99%

“…Bleeding in patients with liver cirrhosis is mostly a consequence of underlying portal hypertension, and anticoagulation therapy has recently been shown not to be a predictive factor for early failure to control bleeding or mortality in cirrhotic patients presenting with upper gastrointestinal bleeding [1,2,7,15…”

Section: Prevention Of Bleeding Complications In Patients Receiving Amentioning

confidence: 99%

“…Screening for esophageal varices (EV) should be undertaken before initiation of anticoagulation [1,7]. Given that the survival of cirrhotic patients decreases dramatically once esophageal variceal bleeding (EVB) occurs, EV should be treated adequately before initiation of anticoagulation [1].…”

Section: Prevention Of Bleeding Complications In Patients Receiving Amentioning

confidence: 99%

See 2 more Smart Citations

Optimal Management of Portal Vein Thrombosis in Patients with Liver Cirrhosis: a Review

Huard

Bissonnette

Bilodeau

2015

Curr Hepatology Rep

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Portal vein thrombosis (PVT) is a fairly common complication of cirrhosis, especially in patients with advanced liver disease and reduced portal vein flow velocity. Prospective studies have shown that its occurrence parallels rather than causes the progression of liver disease and that spontaneous regression is a frequent finding. PVT occurrence is associated with an increased mortality after liver transplantation. Treatment options include anticoagulation and insertion of a transjugular intrahepatic portosystemic shunt. Anticoagulation with vitamin K antagonists or low-molecular-weight heparins achieves partial or complete portal vein recanalization in most patients. Anticoagulation does not seem to increase the bleeding risk when proper prophylaxis of variceal bleeding is applied. Monitoring of anticoagulation difficulties exist, inherent to the coagulopathy of chronic liver disea se . Pla ce men t of a tra ns jug ula r intra he pa tic portosystemic shunt is an alternative in selected patients. Trials are underway to evaluate the potential benefit of PVT prophylaxis with low-molecular-weight heparins.

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Hepatic Venous Outflow Syndromes and Splanchnic Venous Thrombosis

Elkrief

Valla

2019

Evidence‐based Gastroenterology and Hepatology 4e

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Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis of observational studies

Cited by 136 publications

References 59 publications

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Optimal Management of Portal Vein Thrombosis in Patients with Liver Cirrhosis: a Review

Hepatic Venous Outflow Syndromes and Splanchnic Venous Thrombosis

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