Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis

Abstract

Background/AimsPortal-vein thrombosis (PVT) develops in 10-25% of cirrhotic patients and may aggravate portal hypertension. There are few data regarding the effects of anticoagulation on nonmalignant PVT in liver cirrhosis. The aim of this study was to elucidate the safety, efficacy, and predictors of response to anticoagulation therapy in cirrhotic patients.MethodsPatients with liver cirrhosis and nonmalignant PVT were identified by a hospital electronic medical record system (called BESTCARE). Patients with malignant PVT, Budd-Chiari syndrome, underlying primary hematologic disorders, or preexisting extrahepatic thrombosis were excluded from the analysis. Patients were divided into two groups (treatment and nontreatment), and propensity score matching analysis was performed to identify control patients. The sizes of the thrombus and spleen were evaluated using multidetector computed tomography.ResultsTwenty-eight patients were enrolled in this study between 2003 and 2014: 14 patients who received warfarin for nonmalignant PVT and 14 patients who received no anticoagulation. After 112 days of treatment, 11 patients exhibited significantly higher response rates (complete in 6 and partial in 5) compared to the control patients, with decreases in thrombus size of >30%. Compared to nonresponders, the 11 responders were older, and had a thinner spleen and fewer episodes of previous endoscopic variceal ligations, whereas pretreatment liver function and changes in prothrombin time after anticoagulation did not differ significantly between the two groups. Two patients died after warfarin therapy, but the causes of death were not related to anticoagulation.ConclusionsWarfarin can be safely administered to cirrhotic patients with nonmalignant PVT. The presence of preexisting portal hypertension is a predictor of nonresponse to anticoagulation.

Optimal Management of Portal Vein Thrombosis in Patients with Liver Cirrhosis: a Review

“…According to recent evidence, cirrhosis is no longer considered a hypocoagulable state but might rather be a hypercoagulable state [1,2]. The concept of rebalanced hemostasis has emerged, explained by a reduced hepatic production of procoagulant and anticoagulant factors (antithrombin, protein C, protein S, etc.)…”

“…Bleeding in patients with liver cirrhosis is mostly a consequence of underlying portal hypertension, and anticoagulation therapy has recently been shown not to be a predictive factor for early failure to control bleeding or mortality in cirrhotic patients presenting with upper gastrointestinal bleeding [1,2,7,15…”

“…Screening for esophageal varices (EV) should be undertaken before initiation of anticoagulation [1,7]. Given that the survival of cirrhotic patients decreases dramatically once esophageal variceal bleeding (EVB) occurs, EV should be treated adequately before initiation of anticoagulation [1].…”

“…Given that the survival of cirrhotic patients decreases dramatically once esophageal variceal bleeding (EVB) occurs, EV should be treated adequately before initiation of anticoagulation [1]. However, given the lack of evidence on this topic, no firm recommendations can be made regarding the type of prophylaxis to use.…”

“…As the survival of patients with liver cirrhosis has increased over the years, physicians now frequently encounter complex situations in this population [1]. One of these is the management of non-neoplastic portal vein thrombosis (PVT), which is the most common thrombotic complication seen in cirrhotic patients [2][3][4].…”