Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Sato, Ayako; Watanabe, Sho; Iseki, Mari; Yamada, Yurina; Kobayashi, Ryohei; Furuya, Makoto; Arai, Katsuhiro; Ohshina, Eri; Tashiro, Yoshihiro; Nozaka, Takahito; Matsuoka, Mana; Yauchi, Masato; Kobayashi, Katsumasa; Matsumoto, Taichi; Furumoto, Yohei; Asano, Toru; Azuma, Seishin

doi:10.1111/hepr.13942

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…However, the recurrence rate is high, estimated at 30% 20 . Recently, anticoagulation therapy was shown to reduce the risk of cirrhosis-related complications and improve survival in patients with cirrhotic PVT 21 . Therefore, PVT should eventually be treated with therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis

Tadokoro,

Tani,

Manabe

et al. 2024

Sci Rep

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Portal vein thrombosis (PVT) worsens the long-term prognosis of patients with cirrhosis; however, the optimal treatment remains to be determined. Reports on the efficacy of direct oral anticoagulants are increasing, and further evidence is needed. Therefore, we investigated the effectiveness of treatment with edoxaban in patients with PVT. We retrospectively reviewed the outcomes of edoxaban and warfarin as antithrombotic therapies for PVT. The median overall survival time was 4.2 years in patients with PVT, with a 1-year survival rate of 70.7% and a 5-year survival rate of 47.9%. The leading cause of death was hepatocellular carcinoma. The overall response rate for thrombolysis in the edoxaban group was 76.7% compared to 29.4% in the warfarin group, and edoxaban significantly improved PVT compared to warfarin. In addition, edoxaban provided long-term improvement of PVT. Warfarin, on the other hand, was temporarily effective but did not provide long-term benefits. The Child–Pugh and albumin-bilirubin scores did not change after edoxaban or warfarin use. No deaths occurred due to adverse events associated with edoxaban or warfarin. Edoxaban as a single agent can achieve long-term recanalization without compromising the hepatic reserves. Edoxaban is easy to initiate, even in an outpatient setting, and could become a major therapeutic agent for the treatment of PVT.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis

Tadokoro,

Tani,

Manabe

et al. 2024

Sci Rep

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“…However, the recurrence rate is high, estimated at 30% 19 . Recently, anticoagulation therapy was shown to reduce the risk of cirrhosis-related complications and improve survival in patients with cirrhotic PVT 20 . Therefore, PVT should eventually be treated with therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Edoxaban in Portal Vein Thrombosis Associated with Liver Cirrhosis

Tadokoro,

Tani,

Manabe

et al. 2023

Preprint

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Portal vein thrombosis (PVT) worsens the long-term prognosis of patients with cirrhosis; however, the optimal treatment remains to be determined. Reports on the efficacy of direct oral anticoagulants are increasing, and further evidence is needed. Therefore, we investigated the effectiveness of treatment with edoxaban in patients with PVT. We retrospectively reviewed the outcomes of edoxaban and warfarin as antithrombotic therapies for PVT. The median overall survival time was 4.2 years in patients with PVT, with a 1-year survival rate of 70.7% and a 5-year survival rate of 47.9%. The leading cause of death was hepatocellular carcinoma. Compared to warfarin, edoxaban significantly improved PVT. In addition, edoxaban provided long-term improvement of PVT. Warfarin, on the other hand, was temporarily effective but did not provide long-term benefits. The Child-Pugh and albumin-bilirubin scores did not change after edoxaban or warfarin use. No deaths occurred due to adverse events associated with edoxaban or warfarin. Edoxaban as a single agent can achieve long-term thrombolysis without compromising the hepatic reserves. Edoxaban is easy to initiate, even in an outpatient setting, and could become a major therapeutic agent for the treatment of PVT.

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“…A recent study evaluated the course of PVT in cirrhotic patients, comparing two groups (untreated control vs. anticoagulation group). Overall survival was significantly higher in the anticoagulated patients compared with the control group ( p = 0.041); there was also a significant PVT size reduction in the treated group (53.3 vs. 108.2%, p = 0.009) [ 120 ]. During follow-up, the treated group displayed a lower ALBI score ( p = 0.037) and a significantly lower prevalence of massive ascites ( p = 0.043) compared with the control group [ 120 ].…”

Section: Pvt Therapymentioning

confidence: 99%

“…Overall survival was significantly higher in the anticoagulated patients compared with the control group ( p = 0.041); there was also a significant PVT size reduction in the treated group (53.3 vs. 108.2%, p = 0.009) [ 120 ]. During follow-up, the treated group displayed a lower ALBI score ( p = 0.037) and a significantly lower prevalence of massive ascites ( p = 0.043) compared with the control group [ 120 ]. The incidence of clear encephalopathy was also reduced in the anticoagulation group ( p = 0.041) [ 120 ].…”

Section: Pvt Therapymentioning

confidence: 99%

“…During follow-up, the treated group displayed a lower ALBI score ( p = 0.037) and a significantly lower prevalence of massive ascites ( p = 0.043) compared with the control group [ 120 ]. The incidence of clear encephalopathy was also reduced in the anticoagulation group ( p = 0.041) [ 120 ]. There was no difference in the cumulative incidence of bleeding events between the two groups [ 120 ].…”

Section: Pvt Therapymentioning

confidence: 99%

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Portal Vein Thrombosis: State-of-the-Art Review

Boccatonda,

Gentilini,

Zanata

et al. 2024

JCM

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Background: Portal vein thrombosis (PVT) is a rare disease with an estimated incidence of 2 to 4 cases per 100,000 inhabitants. The most common predisposing conditions for PVT are chronic liver diseases (cirrhosis), primary or secondary hepatobiliary malignancy, major infectious or inflammatory abdominal disease, or myeloproliferative disorders. Methods: PVT can be classified on the basis of the anatomical site, the degree of venous occlusion, and the timing and type of presentation. The main differential diagnosis of PVT, both acute and chronic, is malignant portal vein invasion, most frequently by hepatocarcinoma, or constriction (typically by pancreatic cancer or cholangiocarcinoma). Results: The management of PVT is based on anticoagulation and the treatment of predisposing conditions. The aim of anticoagulation in acute thrombosis is to prevent the extension of the clot and enable the recanalization of the vein to avoid the development of complications, such as intestinal infarction and portal hypertension. Conclusions: The treatment with anticoagulant therapy favors the reduction of portal hypertension, and this allows for a decrease in the risk of bleeding, especially in patients with esophageal varices. The anticoagulant treatment is generally recommended for at least three to six months. Prosecution of anticoagulation is advised until recanalization or lifelong if the patient has an underlying permanent pro-coagulant condition that cannot be corrected or if there is thrombosis extending to the mesenteric veins.

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Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Cited by 5 publications

References 30 publications

Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis

Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis

Effectiveness of Edoxaban in Portal Vein Thrombosis Associated with Liver Cirrhosis

Portal Vein Thrombosis: State-of-the-Art Review

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