Recurrent acute portal vein thrombosis in liver cirrhosis treated by rivaroxaban

Abstract

Cirrhosis can occur with the development of portal vein thrombosis (PVT). PVT may aggravate portal hypertension, and it can lead to hepatic decompensation. The international guideline recommends for anticoagulation treatment to be maintained for at least 3 months in all patients with acute PVT. Low-molecular-weight-heparin and changing to warfarin is the usual anticoagulation treatment. However, warfarin therapy is problematic due to a narrow therapeutic window and the requirement for frequent dose adjustment, which has prompted the development of novel oral anticoagulants for overcoming these problems. We report a 63-year-old female who experienced complete resolution of recurrent acute PVT in liver cirrhosis after treatment with rivaroxaban.

Evaluation and management of acute and chronic portal vein thrombosis in patients with cirrhosis

“…Novel oral anticoagulants are not well studied in patients with cirrhosis, but they are desirable due to the ability to avoid both injections and laboratory monitoring. Although not formally recommended, case reports have been published that document success in recanalization with rivaroxaban …”

“…Although not formally recommended, case reports have been published that document success in recanalization with rivaroxaban. 12 Experts recommend at least 6 months of anticoagulation therapy in acute PVT, and longer if patients have evidence of mesenteric thrombus extension or an underlying prothrombotic condition. 7 Anticoagulation in patients with cirrhosis and PVT is an individualized decision for each patient, but it is generally recommended if patients are symptomatic or have progression of their liver disease.…”

Retrospective analysis of the efficacy and safety of rivaroxaban in the treatment of hepatic sinus obstruction syndrome caused by Gynura segetum

“…A study showed that the VTE recurrence and bleeding rates for NOACs used for VTE-AL are not different from those in patients with VTE-TL and are similar to those for enoxaparin [17] . Studies on PVT show that rivaroxaban is effective in the treatment of PVT with a low risk of bleeding and is superior to traditional oral drugs [11,18,19] . At present, there are few studies on the application of rivaroxaban in patients with liver cirrhosis and liver dysfunction.…”

New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

“…64 After 6 months of treatment, DOACs seem as effective as traditional anticoagulants in achieving recanalization. [65][66][67] Recently, an RCT comparing rivaroxaban with warfarin suggested that rivaroxaban was superior to warfarin, with a higher recanalization rate, better survival, and fewer side effects. 58 However, a very specific population (hepatitis C virus related compensated cirrhosis developing PVT after splenectomy) was included in this study, and therefore these results need to be interpreted with caution, as the pathophysiology of PVT in this setting is likely related to surgery and distinct from the typical PVT seen in cirrhosis.…”