Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis

Chen, Hui; Liu, Lei; Qi, Xingshun; He, Chuangye; Wu, Feifei; Fan, Daiming; Han, Guohong

doi:10.1097/meg.0000000000000482

Cited by 105 publications

(85 citation statements)

References 30 publications

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“…Emerging evidence has shown that spontaneous recanalization of the PV may occur. This has been evaluated in at least 8 studies, including 316 patients with cirrhosis, most of them with partial PVT [11][12][13]16,47,[56][57][58] (Table 3). Complete or partial recanalization was reported in 141 (44.6%) of these patients with the reported recanalization rate ranging from 0% to 69%.…”

Section: Management Of Portal Vein Thrombosis In Candidates For Livermentioning

confidence: 99%

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Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on the liver disease progression, especially when it is nonocclusive. PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulation is approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported, but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a "conventional" end-to-end portal anastomotic technique is used, there is not a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT and can preclude future options for re-LT. Liver Transpl 22:352-365, 2016. V C 2015 AASLD.

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Section: Management Of Portal Vein Thrombosis In Candidates For Livermentioning

confidence: 99%

“…To date, 10 studies have evaluated the safety and efficacy of anticoagulation for PVT in liver cirrhosis 16,[56][57][58][59][60][61][62][63][64] (Table 4). Most of them were retrospective, have small sample sizes, and the majority of patients had partial nonocclusive PVT.…”

Section: Anticoagulationmentioning

confidence: 99%

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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“…Among studies that evaluated the efficacy of AC for recanalization, OR ranged from 2.75 to 15.52 with a summary OR of 6.00 (95% CI: 2.38-15.07; Figure 2). 30,31,33,36 Heterogeneity among these studies was not significant (P ¼ .65, I 2 ¼ 0%).…”

Section: Anticoagulation Versus Tips For Pvt: Recanalization Of the Pmentioning

confidence: 92%

“…One study, however, had only 3.8 months mean follow-up, 31 and 2 studies did not specify mean or median follow-up. 32,33 Among studies evaluating AC, 3 used vitamin K antagonists (VKAs), 30,31,33 and 1 used low-molecular-weight heparin (LMWH). 36 Duration of AC ranged from 4 to 12 months.…”

Section: Selected Studiesmentioning

confidence: 99%

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

Davis

Ogurick

Rothermel

et al. 2019

Clin Appl Thromb Hemost

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Portal vein thromboses (PVTs) are associated with hepatic decompensation, worse survival, and worse liver transplant outcomes. We evaluated the impact of anticoagulation (AC) and transjugular intrahepatic portosystemic shunting (TIPS) on recanalization and mortality in patients with cirrhosis and PVT. Systematic search of electronic databases was performed. Clinical trials and observational studies that evaluated primary outcomes of recanalization and survival in patients with cirrhosis having PVT treated with AC or TIPS were included. Risk of bias was assessed. Summary odds ratios (ORs) for pooled data from the included studies were generated using a random effects model. A total of 505 studies were screened for inclusion. After review, 7 studies were ultimately included. Data from 327 patients in total were evaluated. Overall, treatment with either AC or TIPS resulted in partial or complete recanalization (OR: 4.56 [95% confidence interval, CI: 2.46-8.47]) but did not significantly impact mortality (OR: 0.57 [95% CI: 0.21-1.57]). The summary OR of AC for recanalization was 6.00 (95% CI: 2.38-15.07). The summary OR of TIPS for recanalization was 3.80 (95% CI: 1.47-9.83). The summary OR of mortality in patients treated with AC for PVT was 0.28 (95% CI: 0.08-0.95). The mortality summary OR was 1.10 (95% CI 0.23-5.16) in patients who underwent TIPS. There was insufficient data to assess complications such as hepatic encephalopathy or bleeding. Both AC and TIPS have a significant effect on recanalization. Anticoagulation appears to have a protective effect on mortality that is not seen with TIPS. More studies with control groups are need.

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“…[21] Treatment with vitamin K antagonists (VKA) has been the focus of several studies. [22][23][24] For instance, Francoz et al evaluated the standard anticoagulant treatment, consisting of LMWH overlapped and followed by VKA (INR target range 2.0-3.0), in 19 cirrhotic patients with PVT on the waiting list for liver transplant. [22] Recanalization was significantly more common in the treated patients (42.1% vs. none of those not treated), but one episode of upper gastrointestinal bleeding developed.…”

Section: Journal Of Translational Internal Medicine / Jan-mar 2018 / mentioning

confidence: 99%

Timing of anticoagulation for portal vein thrombosis in liver cirrhosis: An Italian internist’s perspective

Riva

Ageno

2018

Journal of Translational Internal Medicine

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Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis

Abstract: Anticoagulation with warfarin might result in the resolution of more advanced PVT effectively and safely in patients with liver cirrhosis. In addition, we did not demonstrate the benefit of anticoagulation for the decompensation or death.

Cited by 105 publications

References 30 publications

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

Timing of anticoagulation for portal vein thrombosis in liver cirrhosis: An Italian internist’s perspective

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