Association between portal vein thrombosis and risk of bleeding in liver cirrhosis: A systematic review of the literature

Qi, Xingshun; Su, Chunping; Ren, Weirong; Yang, Man; Jia, Jia; Dai, Junna; Xu, Wei; Guo, Xiaozhong

doi:10.1016/j.clinre.2015.02.012

Cited by 40 publications

(31 citation statements)

References 43 publications

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“…36 Qi et al in their systemic review, which included 18 randomized controlled trials, found that PVT is significantly associated with UGIB in patients with liver cirrhosis. 37 Our results showed the same effect of PVT on UGIB incidence as PVT was present in 63/71 (88.7%) patients.…”

Section: Discussionsupporting

confidence: 80%

Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

Fouad

Abdelsameea

Abdel-Razek

et al. 2019

J of Gastro and Hepatol

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Background and Aim Upper gastrointestinal bleeding (UGIB) is a serious complication of portal hypertension in cirrhotic patients. The objective of this study is to identify the risk factors for morbidity and mortality occurring after an UGIB attack. Methods A total of 1097 UGIB attacks in 690 patients with liver cirrhosis were studied. Their clinical, laboratory, and endoscopic data were reviewed. Results Mean age 53.2 ± 10.6 (20–90) years, 78% men and the main cause of liver disease was hepatitis C (94.9%). Complications occurred after 467 attacks (42.6%): hepatic encephalopathy 31.4%, spontaneous bacterial peritonitis 18%, renal impairment 13.2%, and re‐bleeding in 7.8%, while 199 patients (18.1%) died. Complications followed 78.4% of bleeding from gastric varices, 75% of post‐interventional ulcers, 10.8% of peptic ulcers, and 5.9% of telangiectasias. By univariate analysis: packed red blood cells units transfused, transaminases, Child–Pugh (CP), model of end‐stage liver disease (MELD), and albumin–bilirubin (ALBI) scores, beside the presence of hepatocellular carcinoma (HCC), previous hemorrhage in the previous 6 months, and the source of bleeding, were associated with occurrence of complications. By multivariate analysis, independent predictors of complications were CP, MELD, and ALBI scores (odds ratio, 95% confidence interval: 5.63, 3.55–8.93; 1.15, 1.11–1.19; and 2.11, 1.4–3.19, respectively) beside the presence of HCC (4.89, 2.48–9.64). Mortality predictors were packed red blood cells units transfused (1.11, 1.01–1.24), CP (5.1, 1.42–18.25) MELD (1.27, 1.21–1.32) scores, and presence of HCC (6.62, 2.93–14.95). Conclusion High CP, MELD, and ALBI scores beside the presence of HCC could predict poor outcome of UGIB. In the absence of these risk factors, early discharge could be considered if the source of bleeding is peptic ulcer or telangiectasia.

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Section: Discussionsupporting

confidence: 80%

Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

Fouad

Abdelsameea

Abdel-Razek

et al. 2019

J of Gastro and Hepatol

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“…ILF is associated with increased bleeding risk and has been included in a bleeding risk scoring system for assessing the 1‐year risk of major bleeding associated with warfarin therapy in patients with AF 2, 3, 4. In addition, hepatitis‐related chronic liver disease and cirrhosis are prevalent in Asia and are associated with higher risks of ischemic stroke, portal vein thrombosis, intracranial hemorrhage, and variceal bleeding 5, 6, 7, 8. Non–vitamin K antagonist oral anticoagulant (NOAC) represents a major advance in stroke prevention for AF patients, offering at least equivalent efficacy and less bleeding compared with warfarin 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

Wang

Kuo

et al. 2018

JAHA

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BackgroundPatients with impaired liver function (ILF) were excluded from clinical trials that investigated non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of NOACs in atrial fibrillation patients with ILF.Methods and ResultsA cohort study based on electronic medical records was conducted from 2009 to 2016 at a multicenter healthcare provider in Taiwan and included 6451 anticoagulated atrial fibrillation patients (aged 76.7±7.0 years, 52.5% male). Patients were classified into 2 subgroups: patients with normal liver function (n=5818) and patients with ILF (n=633, 9.8%). Cox regression analysis was performed to investigate the risks of thromboembolism, bleeding, and death associated with use of NOACs and warfarin in patients with normal liver function and ILF, respectively. In patients with normal liver function, compared with warfarin therapy (n=2928), NOAC therapy (n=4048) was associated with significantly lower risks of stroke or systemic embolism (adjusted hazard ratio: 0.75; 95% confidence interval, 0.65–0.88; P<0.001) and death (adjusted hazard ratio: 0.69; 95% confidence interval, 0.60–0.80; P<0.001) with no difference in major bleeding or gastrointestinal bleeding. In patients with ILF, compared with warfarin therapy (n=394), NOAC therapy (n=342) was associated with significantly lower risk of death (adjusted hazard ratio: 0.64; 95% confidence interval, 0.49–0.83; P<0.001), but no difference in stroke or systemic embolism, major bleeding, or gastrointestinal bleeding.ConclusionsIn atrial fibrillation patients with ILF, NOAC therapy and warfarin therapy were associated with similar risks of stroke or systemic embolism, major bleeding, and gastrointestinal bleeding.

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“…Portal vein thrombosis (PVT) negatively influences the outcomes of cirrhotic patients (1)(2)(3)(4)(5)(6). However, no consensus regarding the treatment strategy of PVT in cirrhosis is well established (7,8).…”

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confidence: 99%

Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis: outcomes and predictors in a prospective cohort study

Guo

et al. 2015

Liver International

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Association between portal vein thrombosis and risk of bleeding in liver cirrhosis: A systematic review of the literature

Cited by 40 publications

References 43 publications

Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis: outcomes and predictors in a prospective cohort study

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