Efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis: A meta-analysis

Gao, Yupeng; Liu, Hua; Tang, Fei; Zhang, Xu; Li, Fenghui; Ye, Qing; Yuan, Haixia; Lv, Hongmin; Han, Tao

doi:10.1016/j.clinre.2021.101649

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…In patients with cirrhosis without HCC, several studies have reported that in most cases, partial PVT resolves spontaneously or remains stable, with rates up to 42% and 70%, respectively 4,39,40 . On the contrary, in the present cohort, the progression rate in untreated patients was much higher (62.7%) compared with pooled rates in patients without HCC (29%–33%) 40,41 . Also, the spontaneous recanalization rate was minimal (6.7%), compared with patients without HCC (22%–42%), 40,41 .…”

Section: Discussioncontrasting

confidence: 60%

“…[4,39,40] On the contrary, in the present cohort, the progression rate in untreated patients was much higher (62.7%) compared with pooled rates in patients without HCC (29%-33%). [40,41] Also, the spontaneous recanalization rate was minimal (6.7%), compared with patients without HCC (22%-42%), [40,41] . The only factor influencing the pattern of PVT progression was HCC response to treatment, suggesting that tumor persistence may hinder thrombosis regression regardless of PVT characteristics at diagnosis, thus leaving little room for monitoring in the absence of therapy.…”

Section: Discussionmentioning

confidence: 97%

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Role of nonneoplastic PVT in the natural history of patients with cirrhosis and first diagnosis of HCC

Senzolo,

Shalaby,

Grasso

et al. 2023

Hepatology

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Background & Aims: Hepatocellular carcinoma (HCC) can increase the risk of non-neoplastic portal vein thrombosis (PVT) in cirrhosis. However, natural history of PVT and its prognostic role in HCC patients are unknown. Approach & Results: Consecutive cirrhotic HCC patients undergoing laparoscopic ablation were retrospectively evaluated and followed-up to 36 months. HCC and PVT characteristics and evolution were reviewed. PVT was categorized according to lumen occupancy (≤ 50%, > 50% < 100% and = 100%) and extension to other veins. Evolution of thrombosis was considered at 1 year from diagnosis. Variables associated with presence of PVT and evolution patterns were analyzed, as well as their impact on survival. Seven-hundreds-fifty patients were included, 88 with PVT. On multivariate analysis, the occurrence of PVT at HCC diagnosis was associated with pre-treatment total tumor volume (p < 0.001) and clinically-significant portal hypertension (p = 0.005). During follow-up, 46 de novo PVT occurred, 27/46 (58.7%) in presence of viable tumor. Among 115 PVT diagnosed in presence of HCC, 83 had available radiological follow-up, and 22 were anticoagulated. The ‘complete/progressive’ evolution pattern was associated with non-response to HCC treatment in non-anticoagulated patients. The presence of PVT was independently associated with lower overall survival, particularly when progressive or occlusive (p < 0.001). A higher competing risk of death emerged for ‘complete and progressive’ PVT, both for HCC-related (p < 0.001) and non-HCC-related (p = 0.002) death. Conclusions: HCC represents an independent risk factor for the occurrence and progression of PVT in cirrhosis. Since progressive and occlusive PVT seems to be an independent factor associated with mortality, screening and prompt treatment of this complication should be considered.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 97%

Role of nonneoplastic PVT in the natural history of patients with cirrhosis and first diagnosis of HCC

Senzolo,

Shalaby,

Grasso

et al. 2023

Hepatology

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“…Similar results are reported by Gao et al ,8 who conducted a meta-analysis and reported decreased rates of portal hypertension-related bleeding. Another study by Condat et al 12 revealed that anticoagulation use does not increase the risk or severity of bleeding in patients with PVT. The likely explanation for decreased gastro-oesophageal variceal bleeding after anticoagulation use in patients with PVT is reduced portal pressure, which ultimately prevents varicose vein rupture 20.…”

Section: Discussionmentioning

confidence: 97%

“…On the other hand, before starting anticoagulation in patients with cirrhosis with PVT, a few factors need to be considered, including the risk of bleeding, thrombocytopaenia and complications and the extent of the thrombosis 7 10 11. There is increasing evidence supporting the safety of anticoagulation use in patients with PVT with cirrhosis 12…”

Section: Introductionmentioning

confidence: 99%

Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database

Tarar

Farooq

Kamal

et al. 2022

Postgraduate Medical Journal

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Background and aimAnticoagulation use for portal vein thrombosis (PVT) in patients with advanced liver disease is controversial. We investigated the effect of anticoagulation on outcomes in patients with PVT with cirrhosis.MethodsWe reviewed National Inpatient Sample data from 2016 to 2018 to identify patients with PVT. Our outcomes were in-hospital mortality, variceal bleeding, hepatic encephalopathy, acute kidney injury (AKI), hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), sepsis and hospital resource utilisation.ResultsWe included 60 505 patients with PVT, out of whom 6.63% (4015) were on anticoagulation. The overall mortality in the anticoagulation group was 2.12% compared with 9.72% in the no anticoagulation group. The adjusted odds of mortality were low in the anticoagulation group (adjusted OR (AOR) 0.27, 95% CI 0.15 to 0.46, p<0.001). Patients on anticoagulation had 29% lower odds of variceal bleeding (AOR 0.71, 95% CI 0.53 to 0.96, p=0.03). Lower odds of HRS (AOR 0.56, 95% CI 0.37 to 0.85, p=0.01) and AKI (AOR 0.57, 95% CI 0.48 to 0.69, p<0.001) were also seen in the anticoagulation group. Patients in the anticoagulation group also showed lower odds of SBP (AOR 0.62, 95% CI 0.43 to 0.89, p=0.01) and sepsis (AOR 0.57, 95% CI 0.35 to 0.93, p=0.03). Anticoagulation use resulted in shorter hospital stay by 1.15 days (adjusted length of stay −1.15, 95% CI −1.51 to –0.79, p<0.001). The mean difference in total hospital charges between the anticoagulation and the no anticoagulation group was −$20 034 (95% CI −$27 077 to −$12 991, p<0.001).ConclusionOur analysis found that anticoagulation use is safe and associated with better outcomes in patients with PVT with advanced liver disease.

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“…For patients receiving anticoagulation therapy, major bleeding, and PH‐related bleeding rates range from approximately 3% to 21%; PH is the main cause of severe bleeding (Table 2). 11,68,71,73–75,79,84–87 Furthermore, a significant decrease in the risk of PH‐related bleeding was observed in patients receiving anticoagulant treatment than those without anticoagulant treatment (OR: 0.21), 88 suggesting that recanalization of PVT helped decrease the PV pressure. In patients with PLT counts <50 × 10 9 /L, a strategy of reducing the LMWH dose by 40% may be available, reducing the risk of bleeding but without reducing the efficacy of anticoagulation 89 .…”

Section: Advances In Management Strategies For Pvtmentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis: An updated overview

Xiao

Wang

2023

Portal Hypertension & Cirrhosis

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Portal vein thrombosis (PVT) is a frequent and severe complication in patients with cirrhosis; however, the pathophysiology of PVT needs to be better clarified. There are few significant predictive factors in clinical practice, and the impact of PVT on cirrhosis progression and its complications, such as gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome, remains uncertain. In recent years, the understanding of the mechanisms of PVT has become more profound with the publication of related literature. Therefore, in this review, we aim to summarize the advanced progress in the epidemiology, hazards, risk factors, diagnosis and classification, and treatment of PVT to provide insight into clinical management.

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Efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis: A meta-analysis

Cited by 7 publications

References 32 publications

Role of nonneoplastic PVT in the natural history of patients with cirrhosis and first diagnosis of HCC

Role of nonneoplastic PVT in the natural history of patients with cirrhosis and first diagnosis of HCC

Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database

Portal vein thrombosis in liver cirrhosis: An updated overview

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