Prevention of portal vein thrombosis with anticoagulant therapy in patients with hepatic cirrhosis

Abstract Background: Systematic review and meta-analysis were performed to evaluate efficacy and safety of anticoagulant therapy in patients with chronic cirrhosis complicated with portal vein thrombosis (PVT). Methods: The PubMed, The Cochrane Library and Web of Science databases were searched. The odds ratio (OR) and risks ratio(RR) with 95% CI was pooled to calculate the difference in the rate of portal vein recanalization and occurrence of bleeding events between patients who received anticoagulation and those who did not. All meta-analysis were conducted by using a random-effects model. Results: 8 studies with a total of 559 patients published between 2005 and 2019 were finally enrolled in our meta-analysis . The rate of portal vein recanalization was significantly higher with PVT who received anticoagulation and those who did not (OR = 4.689, 95% (95% CI = 3.274–6.716, P=0.000). And the pooled risk ratio of bleeding between the two groups was 0.828 (95% CI = 0.511–1.343, P=0.444). The heterogeneity was not statistically significant among studies, Begg’s funnel plot and Egger’s linear regression test were performed to evaluate publicantion bias. Conclusion: Anticoagulation therapy can significantly improve the recanalization rate of PVT patients with cirrhosis, and the bleeding related events caused by anticoagulation are relatively low, which is worthy of clinical promotion. However, more prospective trials are needed to know how to use anticoagulants.

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Risk Factors Regarding Portal Vein Thrombosis in Chronic Liver Disease

Acta Medica Transilvanica ◽

10.2478/amtsb-2020-0068 ◽

2020 ◽

Vol 25 (4) ◽

pp. 38-41

Author(s):

Liliana Vecerzan ◽

Romeo Gabriel Mihăilă

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Hepatic Cirrhosis ◽

Vascular Diseases ◽

High Rate ◽

Imaging Method ◽

Vein Thrombosis ◽

Common Causes ◽

Portosystemic Collateral ◽

Collateral Vessels

Abstract The portal vein thrombosis (PVT) is one of the most frequent vascular diseases of the liver, with a high rate of morbidity and mortality. The most common causes of the PVT are hepatic cirrhosis, hepatobiliary neoplasms, inflammatory and infectious abdominal diseases, and myeloproliferative syndromes.(1,2) The natural progress of the PVT has as a result portal hypertension which leads to splenomegaly and the formation of portosystemic collateral vessels, as well as gastroesophageal, duodenal and jejunal varices. Ultrasonography, especially Doppler ultrasound, is the most widely used imaging method to asses, supervise and diagnose PVT in patients with hepatopathies. The purpose of acute PVT treatment is to re-permeabilize the obstructed vessels; the endoscopic ligature of the varices in the eventuality of their rupture is safe and extremely efficient in chronic PVT. To conclude, PVT is the most common hepatic vascular disorder, and its prevalence has increased particularly among the patients with chronic hepatopathies.(3)

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Non tumoral portal vein thrombosis during cirrhosis: Should anticoagulation be proposed?

10.32512/jmr.1.2.2018/4.11. ◽

2018 ◽

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulant Therapy ◽

Control Group ◽

Case Group ◽

Early Introduction ◽

Vein Thrombosis ◽

History Of ◽

One Year ◽

The Impact

Background: Portal vein thrombosis (PVT) is considered as infrequent and pejorative event in cirrhosis. Up to date, many questions remain about therapeutic management. Aim: The objectives of this study were to assess the impact of the PVT on the progression of liver disease, to review the indications for anticoagulation and its repercussions. Materials and methods: A case-control study was conducted over a period of 12 years (2002-2013). It included 484 cases of cirrhosis. Among these patients, 41 had non tumoral portal vein thrombosis (case group). The control group included the remaining 443 patients. Results: In our study, there was no impact of PVT on the natural history of cirrhosis both in terms of complications or survival. Only the early introduction of anticoagulant therapy was associated with a re-permeabilization of portal vein at one year (OR1.6; 95% CI [1.10-2.01]). Prolonged anticoagulation was inversely correlated with recurrent PVT after treatment. However, obtaining a portal vein re-permeabilization was not correlated to a significant gain in terms of prevention of complication related to cirrhosis and survival. Conclusions: results suggest that portal vein thrombosis in patients with cirrhosis is not a formal indication for anticoagulant therapy. It should be reserved for candidates of liver transplantation, those with an extension of the PVT to mesenteric vessels or with severe prothrombotic status. Key words: portal vein thrombosis, cirrhosis, anticoagulation.

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