Anticoagulant therapy for splanchnic vein thrombosis: A systematic review and meta-analysis

Treatment of splanchnic vein thrombosis (SVT) is challenging and evidence to guide therapeutic decisions remains scarce. The objective of this systematic review and meta-analysis was to determine the efficacy and safety of anticoagulant therapy for SVT. MEDLINE, EMBASE, and Clinicaltrial.gov were searched from inception up to December 2019 without language restrictions to include observational studies and randomized controlled trials reporting radiological or clinical outcomes in patients with SVT. Pooled proportions and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Of 4312 records identified by the search, 97 studies including 7969 patients were analyzed. In patients receiving anticoagulation, the rates of SVT recanalization, SVT progression, recurrent VTE, major bleeding, and overall mortality were 58% (95% CI, 51-64), 5% (95% CI, 3-7), 11% (95% CI, 8-15), 9% (95% CI, 7-12), and 11% (95% CI, 9-14), respectively. The corresponding values in patients without anticoagulation were 22% (95% CI, 15-31), 15% (95% CI, 8-27), 14% (95% CI, 9-21), 16% (95% CI, 13-20), and 25% (95% CI, 20-31). Compared with no treatment, anticoagulant therapy obtained higher recanalization (RR 2.39; 95% CI, 1.66-3.44) and lower thrombosis progression (RR 0.24; 95% CI, 0.13-0.42), major bleeding (RR 0.73; 95% CI, 0.58-0.92), and overall mortality (RR 0.45; 95% CI, 0.33-0.60). These results demonstrate that anticoagulant therapy improves SVT recanalization and reduces the risk of thrombosis progression without increasing major bleeding. The incidence of recurrent VTE remains substantial also in anticoagulated patients. Effects were consistent across different subgroups of patients.

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Anticoagulant Treatment for Splanchnic Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0040-1722192 ◽

2021 ◽

Author(s):

Emanuele Valeriani ◽

Marcello Di Nisio ◽

Nicoletta Riva ◽

Omri Cohen ◽

Ettore Porreca ◽

...

Keyword(s):

Systematic Review ◽

Liver Cirrhosis ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Meta Analysis ◽

Anticoagulant Treatment ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Cirrhotic Patients ◽

Overall Mortality

Abstract Background Splanchnic vein thrombosis (SVT) is a common complication in patients with liver cirrhosis. The aim of this study was to evaluate the efficacy and safety of anticoagulant therapy for SVT in cirrhotic patients. Methods In this systematic review and meta-analysis, studies reporting on SVT recanalization and progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were searched in MEDLINE, EMBASE, and ClinicalTrial.gov up to December 2019. Pooled proportions and risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Results A total of 1,475 patients were included in 26 studies (23 observational and 3 randomized controlled trials). In patients receiving anticoagulant therapy, SVT recanalization occurred in 68% (95% CI, 62–74; 571/842 patients; 22 studies), SVT progression in 6% (95% CI, 4–9; 25/748 patients; 22 studies), recurrent VTE in 10% (95% CI, 4–22; 48/399 patients; 7 studies), major bleeding in 6% (95% CI, 4–10; 58/785 patients; 18 studies), and overall mortality in 9% (95% CI, 6–14; 68/787 patients; 17 studies). Anticoagulant treatment was associated with higher SVT recanalization (RR 3.19; 95% CI, 1.42–7.17), lower thrombosis progression (RR 0.28; 95% CI, 0.15–0.52), major bleeding (RR 0.52; 95% CI, 0.28–0.97), and overall mortality (RR 0.42; 95% CI, 0.24–0.73) compared with no treatment. Conclusion Anticoagulant therapy seems to improve vein recanalization and to reduce SVT progression, major bleeding, and overall mortality in cirrhotic patients with SVT. The incidence of recurrent VTE during anticoagulation remains substantial.

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Splanchnic Vein Thrombosis in Liver Cirrhosis After Splenectomy or Splenic Artery Embolization: A Systematic Review and Meta-Analysis

Advances in Therapy ◽

10.1007/s12325-021-01652-7 ◽

2021 ◽

Author(s):

Yanyan Wu ◽

Hongyu Li ◽

Tiansong Zhang ◽

Zhaohui Bai ◽

Xiangbo Xu ◽

...

Keyword(s):

Systematic Review ◽

Liver Cirrhosis ◽

Splenic Artery ◽

Meta Analysis ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis

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Risk of major bleeding during extended oral anticoagulation in patients with first unprovoked venous thromboembolism: a systematic review and meta-analysis protocol

Systematic Reviews ◽

10.1186/s13643-019-1175-5 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Faizan Khan ◽

Miriam Kimpton ◽

Tobias Tritschler ◽

Grégoire Le Gal ◽

Brian Hutton ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Oral Anticoagulation ◽

Meta Analysis ◽

Controlled Trials ◽

Bleeding Events ◽

Major Bleeding Events

Abstract Background The optimal duration of anticoagulation after a first unprovoked venous thromboembolism (VTE) remains controversial. Deciding to stop or continue anticoagulant therapy indefinitely after completing 3 to 6 months of initial treatment requires balancing the long-term risk of recurrent VTE if anticoagulation is stopped against the long-term risk of major bleeding if anticoagulation is continued. However, knowledge of the long-term risk for major bleeding events during extended anticoagulation in this patient population is limited. We plan to conduct a systematic review and meta-analysis to quantify the risk for major bleeding events during extended oral anticoagulation in patients with first unprovoked VTE. Methods Electronic databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials will be systematically searched with the assistance of an information specialist (from inception to March 1, 2019) to identify randomized controlled trials and prospective cohort studies reporting major bleeding during extended oral anticoagulation in patients with first unprovoked VTE, who have completed at least 3 months of initial anticoagulant therapy. Study selection, risk of bias assessment, and data extraction will be performed independently by at least two investigators. The number of major bleeding events and person-years of follow-up will be used to calculate the rate (events per 100 person-years) with its 95% confidence interval for each study cohort, during clinically relevant time periods of extended anticoagulant therapy. Results will be pooled using random effect meta-analysis. Discussion The planned systematic review and meta-analysis will provide reliable estimates of the risk for major bleeding events during extended anticoagulation. This information will help inform patient prognosis and assist clinicians with balancing the risks and benefits of treatment to guide management of unprovoked VTE. Systematic review registration PROSPERO CRD42019128597.

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Prophylactic anticoagulant therapy decreases the incidence of deep vein thrombosis in patients with solid tumors: A systematic review and meta-analysis

Journal of Solid Tumors ◽

10.5430/jst.v7n1p35 ◽

2017 ◽

Vol 7 (1) ◽

pp. 35

Author(s):

Yunjiao Zhou ◽

Gong Yang ◽

Chenglei Huang

Keyword(s):

Systematic Review ◽

Deep Vein Thrombosis ◽

Solid Tumors ◽

Risk Ratio ◽

Major Bleeding ◽

Meta Analysis ◽

Bleeding Events ◽

Vein Thrombosis ◽

And Control ◽

Deep Vein

It is not well understood the efficacy and safety of primary deep vein thrombosis (DVT) prophylaxis of anticoagulants in patients with solid tumors. This systematic review and meta-analysis of randomized controlled trials (RCT) determines the relative ratio of primary DVT, survival rate and bleeding events among patients with solid tumors treated with anticoagulants or placebo. Comprehensive literature searches were conducted through the Pubmed, Ovid MEDLINE and EMBASE databases published from January 1st, 1993 to December 31st, 2015. Statistical analysis was performed by RevMan 5.0 software. For DVT events, therisk ratio in 16 trials between the prophylactic and control patients was statistically significant at 0.45 [0.36-0.58]; for major bleeding events, the risk ratio in 18 trials between the prophylactic and control patients was not statistically significant at 1.33 [0.99-1.79], while that in 15 trials with clinically relevant non-major bleeding was statistically significant at 1.83 [1.46-2.30]; the risk ratio for the mortality rate of patients with solid tumors in 16 trials was not statistically significant at 0.97 [0.93-1.02]. Inconclusion, the risk ratio in this meta-analysis showed a significantly reduced incidence of DVT with anticoagulant use. Treatment to patients who had solid tumors with prophylactic anticoagulants enhanced the incidence rate of non-major bleeding but has no significant impact on the incidence rate of major bleeding. No significant differences were found in the mortality outcomes between anticoagulant and non-anticoagulant groups.

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Restarting oral anticoagulant therapy after major bleeding in atrial fibrillation: A systematic review and meta-analysis

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.03.053 ◽

2018 ◽

Vol 261 ◽

pp. 84-91 ◽

Cited By ~ 9

Author(s):

Marco Proietti ◽

Giulio Francesco Romiti ◽

Imma Romanazzi ◽

Alessio Farcomeni ◽

Laila Staerk ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Meta Analysis

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Prevalence of CALR mutations in splanchnic vein thrombosis: A systematic review and meta-analysis

Thrombosis Research ◽

10.1016/j.thromres.2018.05.007 ◽

2018 ◽

Vol 167 ◽

pp. 96-103 ◽

Cited By ~ 10

Author(s):

Miaomiao Li ◽

Valerio De Stefano ◽

Tingxue Song ◽

Xinmiao Zhou ◽

Zeqi Guo ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Calr Mutations

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S1116 Efficacy and Safety of Direct Oral Anticoagulants in Treatment of Splanchnic Vein Thrombosis: Systematic Review and Meta-analysis

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000777996.54327.1c ◽

2021 ◽

Vol 116 (1) ◽

pp. S525-S525

Author(s):

Natapat Chaisidhivej ◽

Ben Ponvilawan ◽

Angkawipa Trongtorsak ◽

Sahar Sultan ◽

Samapon Duangkham ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Efficacy And Safety ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis

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Incidence of Splanchnic Vein Thrombosis After Abdominal Surgery: A Systematic Review and Meta-analysis

Journal of Surgical Research ◽

10.1016/j.jss.2019.07.086 ◽

2020 ◽

Vol 245 ◽

pp. 500-509 ◽

Cited By ~ 1

Author(s):

Betty Zhang ◽

Minji Kim ◽

Christopher Griffiths ◽

Qian Shi ◽

Emmanuelle Duceppe ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Surgery ◽

Meta Analysis ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis

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Oral anticoagulant use in patients with morbid obesity: A systematic review and meta-analysis

Thrombosis and Haemostasis ◽

10.1055/a-1588-9155 ◽

2021 ◽

Author(s):

Tzu-Fei Wang ◽

Marc Carrier ◽

Karine Fournier ◽

Deborah M. Siegal ◽

Grégoire Le Gal ◽

...

Keyword(s):

Systematic Review ◽

Morbid Obesity ◽

Major Bleeding ◽

Observational Studies ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Efficacy And Safety ◽

Systemic Embolism ◽

Recurrent Vte

Objectives: Obesity is associated with increased risks of atrial fibrillation (AF) and venous thromboembolism (VTE) for which anticoagulation is commonly used. However, data on the efficacy and safety of oral anticoagulants in patients with morbid obesity are limited. Methods: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for AF or VTE in patients with morbid obesity. Results: We included 3 randomized controlled trials (5 studies) and 18 observational studies in adult patients with a body weight ≥ 120 kg, body mass index (BMI) ≥ 40 kg/m2 or classified as morbid obesity who received DOACs or VKAs for AF or VTE (N=77,687). The primary efficacy outcome was stroke/systemic embolism or recurrent VTE, and the primary safety outcome was major bleeding. DOACs were associated with a pooled incidence rate of stroke/systemic embolism of 1.16 per 100 person-years, compared to 1.18 with VKAs. The incidence of recurrent VTE on DOACs was 3.83 per 100 person-years, compared to 6.81 on VKAs. In both VTE and AF populations, DOACs were associated with lower risks of major bleeding compared to VKAs. However, all observational studies had moderate to serious risks of bias. Conclusions: Patients with morbid obesity on DOACs had similar risks of stroke/systemic embolism, lower rates of recurrent VTE and major bleeding events compared to those on VKAs. However, the certainty of evidence was low given that studies were mostly observational with high risk of confounding.

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