Abstract
Background and Aims Portal vein thrombosis is a serious adverse event that occurs during liver cirrhosis. We performed a meta-analysis to evaluate the safety and efficacy of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with (/without) portal vein thrombosis. Methods Eligible comparative studies were identified by searching the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI. A meta-analysis was performed to calculate odds ratios and 95% confidence intervals using fixed-effects models. Recanalization and thrombus progression were defined as the primary outcomes. Secondary outcomes included adverse events and death mortality. Results A total of 3479 patients were included in this analysis. Compared with the control group, the recanalization rate in the anticoagulant therapy group was increased (P < 0.00001) in patients with cirrhosis and portal vein thrombosis without increasing adverse events. Multiple use of enoxaparin in small doses is safer than single large doses (P=0.004). Direct oral anticoagulants are more effective (P < 0.00001) and safer than traditional anticoagulants. Prophylactic anticoagulant therapy can effectively prevent portal vein thrombosis formation (P < 0.00001). Conclusions Anticoagulation therapy can treat or prevent portal vein thrombosis in patients with liver cirrhosis and is a relatively safe treatment.
Highlights
Portal vein thrombosis (PVT) is a common adverse event of liver cirrhosis, and its incidence increases as liver disease progresses and is even higher in patients with various portal hypertension procedures [1,2,3]
1 randomized controlled trials (RCT) or nonrandomized controlled trials (nRCT); 2 study subjects were patients older than 18 years of age with liver cirrhosis at any stage attributed to various etiologies, and there were no restrictions on the race, nationality, or region; 3 the observation group was administered anticoagulants for anticoagulation, and the control group was treated with placebo or blank control, different anticoagulants, or different doses or treatment times with the same anticoagulant; 4 data reported should include these outcome indicators: portal vein recanalization or new onset, bleeding events, death, and other adverse events, including the new onset of decompensation of liver function, ascites, spontaneous peritonitis, sepsis, hepatorenal syndrome, or hepatic encephalopathy
Compared with the control group, anticoagulation did not increase the incidence of bleeding events or the incidence of other adverse events, but the mortality rate was reduced (Figures 2(d)– 2(f ))
Summary
Portal vein thrombosis (PVT) is a common adverse event of liver cirrhosis, and its incidence increases as liver disease progresses and is even higher in patients with various portal hypertension procedures [1,2,3]. Is article is divided into two parts, namely, anticoagulation and prophylactic anticoagulation therapy, and both topics are analyzed using and metaanalysis to provide a reference for clinicians to treat or prevent PVT in patients with cirrhosis. Portal vein thrombosis is a serious adverse event that occurs during liver cirrhosis. We performed a metaanalysis to evaluate the safety and efficacy of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with (/without) portal vein thrombosis. Compared with the control group, the recanalization rate in the anticoagulant therapy group was increased (P < 0.00001) in patients with cirrhosis and portal vein thrombosis without increasing adverse events. Prophylactic anticoagulant therapy can effectively prevent portal vein thrombosis formation (P < 0.00001). Anticoagulation therapy can treat or prevent portal vein thrombosis in patients with liver cirrhosis and is a relatively safe treatment
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