Usage of Direct Acting Oral Anticoagulants in Cirrhotic and Non-Cirrhotic Portal Vein Thrombosis: A Systematic Review

Abstract

Thrombosis of the portal vein (PVT) is generally seen in the setting of liver cirrhosis and to a lesser extent in the absence of cirrhosis. There is no clear guidance in relation to approaching treatment with anticoagulation in this condition. The professional societies and guidelines recommend treatment with traditional anticoagulation like low-molecular-weight heparin and vitamin-K antagonists in patients presenting with acute portal vein thrombosis. There is no clarity in relation to treatment in the setting of chronic PVT and in patients with cirrhosis. Also, the role of direct-acting oral anticoagulants (DOACs) that are becoming a preferred choice for anticoagulation for various other indications is not clear in the case of PVT. There are a very few studies in the medical literature that have investigated the role of DOACs in patients with PVT in different settings. Thus, we performed a systematic review of the literature to study the use of DOACs in PVT in patients with and without cirrhosis. The results of the available studies show that DOACS appears to be a promising choice for the treatment of patients with PVT. The availability of more data in the future along with better availability of the approved reversal agents for various DOACs is expected to make DOACS a preferred choice for the clinicians to treat patients with PVT.

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

“…In two studies on large cohorts of IBD patients with a follow-up time over 10 years, thromboembolic complications were reported in about 1% of patients, with an incidence of VTE of 2.6/1000 persons/year[ 85 , 86 ]. Porto-mesenteric venous system is a frequent site of thrombosis in IBD and is a potentially catastrophic complication, which may lead to bowel ischemia or infarction and to acute or chronic portal hypertension; the mortality rate range between 3%-25%[ 86 , 87 ]. Incidence is higher during disease flares and after surgical procedures[ 88 - 90 ], and prophylactic treatment with low-molecular-weight heparin in severely active disease is indicated by guidelines to reduce the risk of thromboembolism[ 91 ].…”

Concerns about data integrity of 30 randomized clinical trials from one author.

“…Dr Abd-Elsalam's COVID-19 RCTs have garnered nearly 1,000 citations in total and been included in a large number of systematic reviews and clinical practice guidelines. (21)(22)(23) Dr Abd-Elsalam's work prior to the pandemic has also been highly influential, for example Hanafy2019a, an RCT of rivaroxaban and warfarin for portal vein thrombosis that has been cited over 100 times and included in six systematic reviews (24)(25)(26)(27)(28)(29). As a consequence, inappropriate practice recommendations may have been drawn, and inappropriate treatments could have been offered to patients.…”

Risk Factors, Clinical Presentation, Diagnosis, and Treatment Outcomes of Portal Vein Thrombosis: A Five-Year Hospital-Based Study From Qatar

“…DOACs such as rivaroxaban, apixaban, or dabigatran have not been well studied in this patient population. However, a recent systematic review showed that DOACs appear to be a promising choice for the treatment of patients with PVT [29]. Anticoagulation therapy in non-cirrhotic chronic PVT has a controversial role [1][2][3]28].…”