Danaparoid sodium-based anticoagulation therapy for portal vein thrombosis in cirrhosis patients

Abstract

BackgroundPortal vein thrombosis (PVT) is a common complication of cirrhosis. However, in patients with PVT and cirrhosis, there is no clear evidence supporting effective treatment modalities. In this study, we examined the effectiveness and safety of anticoagulation therapy using danaparoid sodium for PVT in patients with cirrhosis.MethodsThis retrospective study assessed 52 cirrhotic patients with PVT treated with danaparoid sodium for 2 weeks between November 2008 and September 2018. The primary outcome measure was the post-treatment status of PVT assessed by reduction in thrombus volume and safety of the therapeutic intervention. PVT status was evaluated with contrast-enhanced computed tomography (CECT). All patients received 1250 units of danaparoid sodium twice daily by intravenous injection for 14 days. Patients on antithrombin III (AT-III) combination therapy were additionally administered 1500 units of AT-III on days 1–5 and days 8–12. Effectiveness was evaluated by CECT from between days 13 and 18. The secondary outcome measure was the prognosis of PVT.ResultsAll patients showed reduction in PVT volume without complications. Return of plasma AT-III level to > 70% during the treatment period contributes to ≥75% reduction of PVT volume. The prognosis in PVT patients depends on hepatic reserve capacity. When limited to Child-Pugh B and C liver cirrhosis patients, a ≥ 75% reduction of PVT volume improved the prognosis.ConclusionsDanaparoid sodium-based anticoagulation therapy was effective and safe for PVT in patients with cirrhosis. Return of plasma AT-III level to the normal range during the treatment period contributes to reduction of PVT volume. A reduction of ≥75% in PVT volume may improve the prognosis of Child-Pugh B and C decompensated cirrhosis patients with PVT.

Investigation of Thrombosis Volume, Anticoagulants, and Recurrence Factors in Portal Vein Thrombosis with Cirrhosis

“…An analysis was performed in those two groups to investigate the correlation factors that affected treatment efficacy. However, this analysis also indicated no significant difference in the correlation factors: the Child–Pugh score, ALBI score, FIB-4 index, plasma AT-III level (this date has been presented in our previous report [ 19 ]), plasma FDP level, plasma DD level, blood platelet count, plasma PT activity, or pretreatment PVT volume ( Figure 3 ). In addition, serum albumin level and total serum bilirubin also revealed no significant difference ( Supplementary Figure S1 ).…”

“…There are several reports in which patients received anticoagulant treatment for at least 6 months [ 20 , 21 ]. On the other hand, previous studies conducted in Japan have reported treatment efficiency with short-term administration of danaparoid sodium for only 2 weeks [ 15 , 19 ]. The short duration of treatment is directly dependent on the health care system and social background of people in Japan.…”

“…The short duration of treatment is directly dependent on the health care system and social background of people in Japan. However, despite 2 weeks being a considerably short time frame, we considered that it was acceptable because danaparoid sodium-based treatment revealed a high reduction rate of PVT (72.0–77.3%) within this short duration [ 15 , 19 ]. Considering the short duration of treatment, the patients were followed-up regularly after treatment and danaparoid sodium was re-administered if PVT recurrence or aggravation was confirmed.…”

“…Previously, we reported danaparoid sodium therapy with and without AT-III anticoagulation therapy for PVT in cirrhosis patients [ 19 ]; in that report, we presented the efficacy and safety of danaparoid and found that the prognosis for PVT patients depended on the hepatic reserve capacity. However, the recurrence of PVT was high.…”

Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis

“…Main characteristics of studies are summarized in Table 1. The sample size ranged from 16 [14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and 14 as abstracts [38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”