Evaluation of the efficacy and safety of direct oral anticoagulants in the treatment of portal vein thrombosis

Abstract

Objective The purpose of this study was to evaluate the efficacy and safety of direct oral anticoagulants vs. warfarin for portal vein thrombosis treatment. Methods This was a single-center, retrospective study. Adult patients initiated on a direct oral anticoagulant or warfarin for treatment of a new portal vein thrombosis were included. The primary failure outcome was the absolute difference in recurrent thromboembolic events 90 days following initiation of a direct oral anticoagulant vs. warfarin. The primary safety outcome was the absolute difference in bleeding events 90 days following initiation of a direct oral anticoagulant vs. warfarin. Descriptive statistics, Fisher’s exact, and Student’s t-tests were utilized as appropriate. Results Thirty-three patients were included. Thirteen (39.4%) patients received direct oral anticoagulants, and 20 (60.6%) received warfarin. None of the patients receiving direct oral anticoagulants experienced a primary failure event compared to four receiving warfarin (P < 0.001). None of the patients receiving direct oral anticoagulants experienced a primary safety event vs. one receiving warfarin (P < 0.001). Conclusion Direct oral anticoagulants appear to be effective and safe in the treatment of portal vein thrombosis and in preventing recurrent thromboembolic events. Future studies with larger sample sizes are warranted to confirm direct oral anticoagulants’ efficacy in portal vein thrombosis.

Usage of Direct Acting Oral Anticoagulants in Cirrhotic and Non-Cirrhotic Portal Vein Thrombosis: A Systematic Review

“…Table 1 shows the author, year, type of study, study group, control group, primary and secondary outcomes, and adverse outcomes of the original studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

“…Overall, DOACs were associated with fewer episodes of major bleeding [24]. A study involving both cirrhotic and non-cirrhotic patients with PVT showed better outcomes in patients treated with DOACs compared to warfarin in terms of treatment failure and adverse events [26]. Thus, the use of DOACs for the treatment of PVT is evolving but remains contentious.…”

Pfortaderthrombosen – therapeutische Möglichkeiten

“…Danach schließt sich das weitere therapeutische Work-up an. Die Datenlage bezüglich der Auswahl der richtigen Antikoagulation ist bislang rudimentär und stützt sich fast ausschließlich auf retrospektive Daten [12][13][14][15][16]. Grundsätzlich gilt es aber zu berücksichtigen, dass der Einsatz von oralen Antikoagulanzien (DOAK) stets "off label" erfolgt.…”

Direct oral anticoagulants for portal vein thrombosis in cirrhosis: Good news from meta-analysis?

“…A first issue regards the quality of the studies included in the meta-analysis [2][3][4][5][6][7][8][9][10][11][12] . Out of eleven studies involving 552 subjects (217 treated with DOAC and 335 treated with VKA), one only was a randomized controlled study (RCT) [4] while the others were retrospective, small or relatively small cohort studies, all with their in-herent biases.…”

“…Only five of 11 studies compared the outcome of PVT recanalization [ 3 , 4 , 7 , 8 , 10 ] with a pooled rate favouring DOAC over VKA, but with heterogeneity substantial and sensitive to study design, as the benefit of DOAC was only observed within the RCT [4] , but not among the cohort studies. As for the other outcomes, only three studies compared the risk of PVT progression [ 3 , 4 , 7 ], only four compared the risk of major bleeding [5][6][7][8] , and only two compared the risk of variceal bleeding [ 3 , 5 ] or death [ 4 , 8 ].…”