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

Abstract

Five hundred fifty-three EVLs were performed in 265 patients (in 215 as a primary prophylaxis): 169 EVLs in 80 on-LMWH and 384 in 185 no-LMWH (4.9 ± 1.1 vs 4.8 ± 1.0 bands/session, respectively; P = .796). Six patients bled (2.2%) without between-groups difference (3.8% on-LMWH vs 1.6% no-LMWH, Log-rank P = .291). Large varices with red marks (100% vs 51.4%, P = .032), number of bands (5.6 ± 0.5 vs 4.6 ± 1.2, P = .004), underlying portal vein thrombosis (66.7% vs 23.6%, P = .033), and creatinine (2.2 ± 2.7 vs 1.0 ± 0.8 mg/dL, P = .001) at index EVL were significantly different between bleeders and non-bleeders. Six patients died within 4-week from index EVL, without between-groups difference (2.5% on-LMWH vs 2.2% no-LMWH, Log-rank P = .863). LMWH does not increase the risk of post-procedural bleeding and does not affect survival of cirrhotic patients undergoing prophylactic EVL.

Is there evidence for stopping anticoagulation therapy before endoscopic variceal ligation?

“…Both of them had extensive PVT and comorbidities. Altogether, the present study suggests that LMWH during prophylactic EVL sessions does not increase the risk of bleeding and death.…”

“…In another setting, we recently observed that in patients with non‐cirrhotic non‐tumoral extrahepatic portal vein obstruction, continuous oral AT during EVL sessions was not associated with a higher risk of upper gastrointestinal bleeding . These 2 studies support the safety of anticoagulation during banding therapy.…”

“…In the present issue of Liver International, Bianchini et al address the clinically relevant question of AT management in cirrhotic patients enrolled in a prophylactic EVL programme. LMWH was administrated continuously throughout EVL sessions until variceal eradication.…”

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

“…Interestingly, continuous administration of anticoagulant treatment with low-molecular-weight heparin (LMWH) did not increase the post-EVL bleeding in these patients. 80…”

New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

“…However, preliminary data suggest that maintaining anticoagulation during EBL sessions do not increase bleeding risk, suggesting that it is not necessary to stop anticoagulation during EBL. 75 These data should be confirmed before making a formal recommendation. On the other hand, NSBB titration can be accelerated to achieve adequate β-blockade rapidly.…”