Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

“…While clear data connecting the coagulative status of cirrhotic patients and their risk of bleeding have never been consistently provided, variceal bleeding has been related to the level of portal hypertension and to the endoscopic characteristics of varices . Our data confirm this evidence and define that there is no apparent causality between post‐EVL variceal bleeding and anticoagulant treatment . Concordantly with the literature, the majority of bleeding episodes (66.6%) happened during the second week after EVL11‐13 both in on‐LMWH and in no‐LMWH.…”

Is there evidence for stopping anticoagulation therapy before endoscopic variceal ligation?

“…Although retrospective, the sample size is considerable. These data confirm one more time that variceal bleeding risk is mainly related to the severity of portal hypertension …”

Recent developments in the field of vascular liver diseases

“…34 Finally, an increasing number of studies have evaluated the most important issue, which is the impact of recanalization on survival and the need for liver transplantation. None of these studies except one 28 found any influence, 29,30,32,35,64,67 although univariate analyses often suggested that recanalization was favourable. On the other hand, several studies have suggested that anticoagulation therapy has an independently positive effect, regardless of recanalization or the severity of liver disease.…”

“…Apparently, this does not agree with an increasing body of data on the impact of recanalization during anticoagulation therapy. Recanalization during anticoagulant therapy is related to improved event‐free survival after adjustment for the severity of liver disease and portal hypertension, improved liver function tests as well as decreased mortality, particularly in patients with the most severe liver disease . It is frustrating to note that no predictors for the resolution of portal vein thrombus have been identified .…”

“…Since this paper was published, a dozen, mainly retrospective studies have been published, largely confirming these findings in a total of 653 patients receiving anticoagulation, and including 312 patients who received anticoagulants compared to 251 patients who did not. [28][29][30][31][32]35,[64][65][66][67] These recent studies show the high risk of recurrence following discontinuation of anticoagulation (43% in 219 patients at risk). Even more interestingly, these studies provide data on additional points that are important for the interpretation of mainly morphological data.…”