Treatment Of Portal Vein Thrombosis In Patients Research Articles

S1169 Efficacy and Safety of Direct Oral Anticoagulants for the Treatment of Portal Vein Thrombosis in Patients With Liver Cirrhosis

Introduction: Studies have reported direct oral anticoagulants (DOACs) to be as effective and safe as traditional anticoagulants (TACs) for portal vein thrombosis (PVT) treatment in cirrhotic patients. However, ideal management remains ambiguous with limited data. Our study was to compare efficacy and safety of DOACs to TACs in cirrhotic patients with PVT. Methods: This is an institutional review board approved, retrospective chart review of four teaching hospitals from January 1st, 2015 to March 31st, 2021. Treatment response and safety were compared in cirrhotic patients on DOACs versus TACs, such as warfarin or low-molecular weight heparin, for PVT. Patients were excluded if they had received anticoagulation for conditions other than PVT, aged < 18, or were pregnant or breastfeeding. Data collected included anticoagulation agent, therapy duration, Child-Turcotte-Pugh class (CTP), radiographic imaging, and adverse medication reactions. We evaluated (1) the rate of progression, non-progression or recanalization of PVT and (2) rate of major bleeding, defined by a hemoglobin drop of ≥ 2, transfusion requirement, or need for reversal antidote. All other events were classified as minor bleeding. Results: A total of 527 patients had PVT and cirrhosis. Ninety-seven patients were initiated on anticoagulation, 53 met study inclusion criteria, and 27 had completed follow-up imaging. Of these 27 patients, 7 were CTP class A, 16 were B, 1 was C, and 3 were unknown at treatment initiation. Ten were on TACs and the remaining 17 were on DOACs. Seven patients (70%) on TACs vs. 14 (82.4%) on DOACs had resolution of PVT, 3 patients (30%) on TACs vs. 1 (5.9%) on DOACs had non-progression of PVT, and 2 (11.8%) on DOACs progressed without recanalization. Six patients (60%) on TACs vs. 14 (82.4%) on DOACs had resolution of PVT within 9 months of anticoagulation initiation. Three out of 10 patients (30%) on TACs and 3 out of 17 patients (17.6%) on DOACs had major bleed. No patients had minor bleed. There was no difference between treatment groups with respect to time of major bleed occurrence. Conclusion: Our study showed that DOACs were effective and safe for the treatment of PVT in patients with cirrhosis. Resolution of PVT in cirrhotic patients appeared to be slightly higher, and bleeding events lower, in those on DOACs compared to those on TACs. Large, prospective studies are warranted to elucidate the optimal use of DOACs in patients with cirrhosis, particularly in CTP class C.

Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis.

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Treatment response and bleeding events associated with anticoagulant therapy of portal vein thrombosis in cirrhotic patients: Systematic review and meta-analysis.

BackgroundWell-defined guidelines for the treatment of portal vein thrombosis (PVT) in patients with cirrhosis are lacking, given the paucity of robust data. Among the available treatment options the best choice is unknown.MethodsWe conducted a comprehensive search of multiple electronic databases and conference proceedings (through December 2019) to identify studies that reported on the use of anticoagulants in the treatment of PVT in patients with cirrhosis. Our goals were to evaluate the pooled odds ratio (OR) and pooled rate of treatment responders and bleeding events.ResultsA total of 17 studies were included: 648 patients were treated with anticoagulation and 96 were controls. Pooled OR for treatment responders was 5.1 (95% confidence interval [CI] 2.5-10.2, P = 0.001) and pooled OR for bleeding was 0.4 (95%CI 0.1-1.5, P = 0.2) for anticoagulation treatment versus control. Pooled rate of treatment responders with anticoagulation was 66.7% (95%CI 58.3-74.1) compared to 26% (95%CI 14.2-42.7) for the control group. Pooled rate of bleeding seemed comparable (7.8%, 95%CI 4.5-13.3, and 15.4%, 95%CI 4.3-42.7). On subgroup analysis, pooled rates of treatment responders and bleeding events seemed similar between low molecular weight heparin, vitamin K antagonists, and direct oral anticoagulants.ConclusionsOur study demonstrated that anticoagulation is effective and safe in the treatment of PVT in patients with cirrhosis. Owing to the comparable outcomes, direct oral anticoagulants may be considered as first-line treatment, depending on patient preferences.

1102 Direct Oral Anticoagulants May Be Used in the Treatment of Portal Vein Thrombosis in Patients With Cirrhosis: A Systematic Review and Comparative Meta-Analysis

INTRODUCTION: Well-defined guidelines for the treatment of portal vein thrombosis (PVT) in patients with cirrhosis do not exist due to lack in robust data. Treatment options include low molecular weight heparin (LMWH), vitamin K antagonists (VKAs), and the newer direct anticoagulants (DOACs). Anticoagulation safety has been an issue in patients with cirrhosis, and the best choice of anticoagulation is unknown. METHODS: We conducted a comprehensive search of multiple databases and conference proceedings (through November 2018) to identify studies that reported on the use of LMWH, VKAs, and DOACs in the treatment of PVT in patients with cirrhosis. Goals were to evaluate the pooled rate of treatment success and bleeding with LMWH, VKAs, and DOACs, and indirectly compare the outcomes. RESULTS: From a total of 744 patients (17 studies), 648 were treated with some form of anticoagulation and 96 were control. 155, 315, and 70 patients were treated with LMWH, VKAs, and DOACs respectively. Baseline characteristics were comparable among the groups. Age ranged from 41 to 71 years with a predominantly male population. 144 patients were Childs A, 182 Childs B, and 121 Childs C. Pooled rate of treatment responders with anticoagulation was 66.7% (95% CI 58.3-74.1, I2 = 72.7) and with control was 26% (95% CI 14.2-42.7, I2 = 36.7). The difference was statistically significant, P = 0.001. Pooled rate of bleeding was similar between these two groups (7.8%, 95% CI 4.5-13.3 and 15.4%, 95% CI 4.3-42.7, P = 0.33). Pooled rates of treatment success and bleeding events were comparable between LMWH, VKAs, and DOACs (Table 1). On meta-regression analysis, Child-Pugh classification did not seem to affect the treatment success and/ or the bleeding outcomes. The calculated 2-sided P-value of intercept was 0.39, Childs A was 0.15, Childs B was 0.11, and Childs C was 0.15. CONCLUSION: Our study demonstrates that anticoagulation is effective and safe in the treatment of PVT in patients with cirrhosis. Bleeding is not increased in treatment group compared to control group. Due to their similar and comparable outcomes, DOACs may be offered as a first line treatment based on patient preferences. Limitations of our study were the comparatively small sample size of patients on DOACs, heterogeneity, and indirect comparison. Well-conducted studies are warranted to ascertain the role of DOACs in the treatment of PVT in patients with cirrhosis.

Portal Vein Thrombosis and Cirrhosis: The Role of Anticoagulation

Purpose of Review Anticoagulation has increasingly been reported as treatment of portal vein thrombosis (PVT) in cirrhosis. However, since the role of PVT in cirrhosis outcome is a debated issue, whether performing treatment of PVT in patients with cirrhosis remains a grey area. The aim of this review was to report an update on management of patients with PVT and cirrhosis.

Efficacy and safety of the anticoagulant drug, danaparoid sodium, in the treatment of portal vein thrombosis in patients with liver cirrhosis.

To assess the efficacy and safety of the anticoagulant drug, danaparoid sodium, in the treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis. A consecutive 26 cirrhotic patients with PVT were enrolled in this retrospective cohort study. The etiologies of cirrhosis were hepatitis B virus-related, hepatitis C virus-related, alcoholic and cryptogenic in five, 14, three and four patients, respectively. Child-Pugh grade A, B and C was noted in 13, eight and five patients, respectively. Patients were treated with 2 weeks' administration of danaparoid sodium followed by the evaluation of PVT reduction and adverse events. All patients experienced reduction of PVT through the treatment. The median volume of PVT before and after treatment was 2.40 cm(3) (range, 0.18-16.63) and 0.37 cm(3) (range, 0-5.74), respectively. The median reduction rate of PVT volume was 77.3% (range, 18-100%). According to the reduction rate, complete reduction (CR), partial reduction (PR, ≥50%) and stable disease (SD, <50%) were observed in four (15%), 16 (62%) and six patients (23%), respectively. The median volume of PVT before treatment was significantly different between CR + PR and SD (2.09 vs 4.35 cm(3) , P = 0.045). No severe adverse events such as bleeding symptoms (e.g. gastrointestinal bleeding and cerebral hemorrhage) and thrombocytopenia were encountered. Danaparoid sodium for the treatment of PVT in patients with liver cirrhosis was safe and effective. Therefore, anticoagulation therapy with danaparoid sodium could have potential as one of the treatment options in PVT accompanied by cirrhosis.

Safety and Efficacy of Anticoagulation Therapy With Low Molecular Weight Heparin for Portal Vein Thrombosis in Patients With Liver Cirrhosis

Treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis is not well established. We intended to assess the safety and efficacy of low molecular weight heparin (LMWH) to treat PVT in cirrhotic patients. All 39 patients diagnosed with non-neoplastic PVT and cirrhosis from June 2005 to December 2006 were evaluated for anticoagulation therapy (AT). PVT was occludent in 15.4%, partial in 64.1%, and portal cavernoma presented in 20.5%. Twenty-eight patients received 200 U/kg/d of enoxaparin for at least 6 months. In 39.3% of patients PVT was an occasional finding, in 10.7% presented with acute abdominal pain, in 50% with bleeding from gastroesophageal varices. In this last group LMWH was started after endoscopic eradication of varices by band ligation. Complete recanalization of portal vein occurred in 33.3%, partial recanalization in 50% and no response in 16.7% of patients. Further 12 patients who continued AT obtained complete recanalization at a median time of 11 months (range 7 to 17 mo). Overall, a complete response was obtained in 75% of patients. No significant side effects, particularly bleeding complications, were observed during the treatment. LMWH demonstrated safe and effective in the treatment of PVT in patients with liver cirrhosis.

Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis

Background Treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis is not well established. Aim We intended to assess the safety and efficacy of low molecular weight heparin (LMWH) to treat PVT in cirrhotic patients. Study All 39 patients diagnosed with non-neoplastic PVT and cirrhosis from June 2005 to December 2006 were evaluated for anticoagulation therapy (AT). PVT was occludent in 15.4%, partial in 64.1%, and portal cavernoma presented in 20.5%. Twenty-eight patients received 200 U/kg/d of enoxaparin for at least 6 months. In 39.3% of patients PVT was an occasional finding, in 10.7% presented with acute abdominal pain, in 50% with bleeding from gastroesophageal varices. In this last group LMWH was started after endoscopic eradication of varices by band ligation. Results Complete recanalization of portal vein occurred in 33.3%, partial recanalization in 50% and no response in 16.7% of patients. Further 12 patients who continued AT obtained complete recanalization at a median time of 11 months (range 7 to 17 mo). Overall, a complete response was obtained in 75% of patients. No significant side effects, particularly bleeding complications, were observed during the treatment. Conclusions LMWH demonstrated safe and effective in the treatment of PVT in patients with liver cirrhosis.