Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis

Ghazaleh, Sami; Beran, Azizullah; Aburayyan, Kanana; Nehme, Christian; Patel, Dipen; Khader, Yasmin; Sharma, Sachit; Aziz, Muhammad; Abdel-Aziz, Yousef; Hammad, Tariq; Nawras, Ali

doi:10.20524/aog.2020.0544

Cited by 21 publications

(20 citation statements)

References 23 publications

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“…74 In addition, meta-analyses and systematic reviews of observational studies of anticoagulation do not describe an increased risk of bleeding; in fact, several studies describe a possibly lower rate of portal hypertension-related bleeding. 75,76 However, no comparative efficacy data from RCTs exist to guide therapy in either the transplant or nontransplant populations. Given the lack of data on the clinical significance of nontumoral PVT and limited data about treatment outcomes, the benefit of routine screening for PVT remains uncertain and the Panel made a conditional recommendation against routine screening.…”

Section: Discussionmentioning

confidence: 99%

AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

O’Shea

Rajasekhar

et al. 2021

Gastroenterology

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Section: Discussionmentioning

confidence: 99%

AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

O’Shea

Rajasekhar

et al. 2021

Gastroenterology

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“…5 While trying to minimize bleeding risk, treatment with lowmolecular-weight heparin or vitamin K antagonists is generally recommended for patients with cirrhosis, 7,9 as this reduces the risk of thromboembolic events (eg, splanchnic and portal vein thrombosis or NVAF) and improves overall outcome. 10,11 DOACs such as apixaban and rivaroxaban are increasingly used as alternative safe and effective treatment options in stable patients, but their role in more advanced liver disease is unclear. 5,7,9 The use of DOACs introduces another level of complexity to coagulation testing in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation

Lucas

Stecker

Pozdnyakova

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Peritoneovenous shunts (PVSs) are used to relieve ascites in cirrhosis. Disseminated intervascular coagulation (DIC) is a complication of PVSs requiring immediate PVS removal. We report a patient who developed new elevations of prothrombin time (PT) and activated partial thromboplastin time (aPTT) 6 hours after PVS placement, concerning for new‐onset DIC. We address the key clinical question of distinguishing DIC from rivaroxaban effect on labs. The patient took rivaroxaban 3 hours after PVS placement, suggesting rivaroxaban effect. Rivaroxaban‐calibrated anti‐Xa level was in the expected treatment range. Over 12 hours, coagulation labs and rivaroxaban levels declined, with no evidence of DIC. The sudden PT/aPTT increase was attributed to rivaroxaban, however, the distinction between DIC and rivaroxaban effect was possible only with the rapid availability of rivaroxaban levels. While there are no US Food and Drug Administration–approved tests for rivaroxaban levels in the United States, this case demonstrates they can have significant clinical impact, encouraging more widespread adaptation of these assays.

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“…Anticoagulant therapy may be safely used in patients with cirrhosis and PVT as either no bleeding complications or only minor bleeding events have been reported [46,61]. Remarkably, two recent meta-analysis have shown a decreased incidence of variceal bleeding in patients under anticoagulation therapy compared to those without [46,62]. However, a platelet count below 50 × 10 9 /L has been identified as a risk factor for bleeding from any site in patients with cirrhosis and PVT receiving anticoagulation [60].…”

Section: Treatmentmentioning

confidence: 99%

Portal Vein Thrombosis in Patients with Cirrhosis

Nery

2021

Vascular Disorders of the Liver

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Epidemiology, Diagnosis and ClassificationPVT has been described to be more frequent in patients with more severe and advanced liver disease. Actually, a bulk of epidemiological data are derived from studies conducted in patients with advanced severe chronic liver disease, e.g. waitlisted for liver transplantation (LT). In the latter context, 1-year incidence of 7.4%[1] has been reported, but prevalence by the time of LT has been estimated between 15.9 and 26% [2, 3]. In a mixed population of patients with cirrhosis stage Child-Pugh A to C, Zocco et al. observed a 1-year incidence of 16.4% [4]. A similar 1-year incidence of 17.9% was found in another cohort of patients with decompensated liver disease [5]. Yet, PVT is also a concern in more stable patients, as it has been found to occur in up to 4.6%, 8.2% and 10.7% at respectively 1-, 3-and 5-years, in a population of mostly compensated liver disease patients [6].As PVT is more commonly a clinically silent event, it is mostly uncovered at Doppler ultrasound (DUS) performed for hepatocellular carcinoma (HCC) screening. Outside the context of LT, there is currently no recommendation to routinely screen for PVT in patients with cirrhosis [7]. PVT diagnosis is generally made by DUS. DUS sensitivity in detecting PVT increases with the degree of occlusion and extension [8]. It may be difficult to differentiate bland thrombi from malignant

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Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis

Cited by 21 publications

References 23 publications

AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation

Portal Vein Thrombosis in Patients with Cirrhosis

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