Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-analysis

Abstract

Based on a systematic review and meta-analysis, patients with cirrhosis and PVT who receive anticoagulant therapy have increased recanalization and reduced progression of thrombosis, compared with patients who do not receive anticoagulants, with no excess of major and minor bleedings and less incidence of variceal bleeding.

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

“…Low molecular weight heparin has already been shown to be safe in patients with cirrhosis not admitted to invasive procedures . We demonstrate the safety of LMWH also in patients otherwise considered at high risk of bleeding for both the endoscopic procedure (ie, EVL) and the underlying disease (ie cirrhosis further complicated by PVT).…”

“…We demonstrate the safety of LMWH also in patients otherwise considered at high risk of bleeding for both the endoscopic procedure (ie, EVL) and the underlying disease (ie cirrhosis further complicated by PVT). Although PVT increases the risk of variceal bleeding in cirrhotic patients and anticoagulation is indicated as its first line treatment, no clear‐cut indication has been provided on the opportunity of performing prophylactic EVL as a concomitant treatment to avoid variceal bleeding . A recent study has shown prophylactic treatment with TIPS as more effective than EVL plus non‐selective betablockers and warfarin for the prevention of rebleeding in patients with non‐cavernomatosus PVT .…”

Suboptimal use of pharmacological venous thromboembolism prophylaxis in cirrhotic patients

“…Historically, thrombocytopenia and abnormal coagulation tests in cirrhosis have been perceived as a reflection of bleeding risk. However, a recent systematic review and meta‐analysis of anticoagulation in cirrhotic patients with portal vein thrombosis, therapeutic anticoagulation was not associated with major or minor bleeding with some studies even reporting lower rates of spontaneous variceal bleeding . Evidence also suggests that a hypercoagulable state persists in cirrhotic patients with thrombocytopenia, at least in part, due to a process in which lipopolysaccharide‐induced platelet sensitisation results in enhanced in vivo platelet activation .…”

Recent developments in the field of vascular liver diseases

“…The most recent systematic review including meta‐analyses of recanalization and the progression of PVT in patients with cirrhosis comparing the effects of anticoagulation therapy to no therapy included eight studies with 353 patients . This study showed that portal vein recanalization was more frequent with anticoagulation than without (complete or partial 71% vs 42%, complete 53% vs 33%, respectively, P < .0001), and that progression was less common (9% vs 33%, respectively, P < .0001).…”