Initiation of anticoagulation therapy within 48-hour after esophageal variceal band ligation is safe in portal vein thrombosis patients having cirrhosis and acute variceal bleeding: A multi-centric randomized controlled trial

Abstract

Background and aims: Portal vein thrombosis (PVT) and acute variceal bleeding (AVB) are recurrent complications of cirrhosis. Safety, efficacy, and initiation time of anticoagulant treatment among cirrhotic patients having PVT and AVB are controversial issues. We aimed to establish the safety and efficacy of nadroparin calcium warfarin sequential (NWS) anticoagulation therapy within 48-hour after esophageal variceal band ligation within PVT patients having cirrhosis and AVB.Methods: Cirrhotic patients having AVB and PVT who underwent EVL were included and randomly allocated to either the NWS therapy group (one-month nadroparin calcium by subcutaneous injection following five-month warfarin through oral administration) or the control group (without any anticoagulation therapy). Five-day failure, 14-day, four-weeks, and six-month rebleeding rates after EVL, other major bleeding events in specific sites, and recanalization rate of PVT among the two groups were assessed at six months. Results: 118 patients were eligible and randomly divided into the NWS group and the control group, with 59 patients in either group. No patients experienced five-day failure in both groups. There was no significant difference in the rate of 14-day (0 vs. 1.7%, P = 1.000), four-week (0 vs. 3.4%, P = 0.476), and six-month rebleeding (11.9% vs. 18.6%, P = 0.36) between the two groups. The overall recanalization (complete and partial) rate in the NWS therapy group was significantly higher than in the control group (67.8% vs. 40.7%, P = 0.003). Low Child-Pugh score (P = 0.005), D-dimer<2.00 ug/mL (P = 0.016), and NWS anticoagulation therapy (P = 0.004) were the predictors of PVT recanalization through univariate analysis of binary logistic regression. NWS anticoagulation therapy (P = 0.004) was the independent factor of recanalization through multivariate analysis. In the NWS group, the Child-Pugh score (6.77 ±1.36 vs. 6.00 ±1.00, P = 0.001) and the albumin level (35.01 ±5.95 vs. 36.95 ±4.27, P = 0.048) were significantly improved at the sixth month.Conclusions: Initiation of NWS anticoagulation therapy within 48-hour after EVL is safe with better efficacy against PVT patients having cirrhosis and AVB. Moreover, it can also improve liver function.