Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis.

Anticoagulants / therapeutic use Humans Liver Cirrhosis / complications Portal Vein / pathology Thrombosis / drug therapy Venous Thrombosis / complications
Anticoagulants Liver cirrhosis Meta-analysis Survival Venous thrombosis

Journal

Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864

Informations de publication

Date de publication:
01 2021
Historique:
received: 23 09 2020
accepted: 23 10 2020
pubmed: 7 11 2020
medline: 15 4 2021
entrez: 6 11 2020
Statut: ppublish

Résumé

Benefit and risk of anticoagulation in cirrhotic patients with portal vein thrombosis (PVT) remain controversial, especially in those with asymptomatic PVT and in non-liver transplant candidates. Furthermore, the predictors of portal vein recanalization and bleeding events after anticoagulation are critical for making clinical decisions, but still unclear. We conducted a meta-analysis to investigate the outcomes of anticoagulation for PVT in liver cirrhosis and explore the predictors of portal vein recanalization and bleeding events after anticoagulation. All studies regarding anticoagulation for PVT in liver cirrhosis were searched via PubMed, EMBASE, and Cochrane Library databases. Thrombotic outcomes, bleeding events, and survival were compared between anticoagulation and non-anticoagulation groups. Predictors of portal vein recanalization and bleeding events were pooled. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Thirty-three studies including 1696 cirrhotic patients with PVT were included. Anticoagulation significantly increased portal vein recanalization (RR = 2.61; 95% CI 1.99-3.43; P < 0.00001) and overall survival (RR = 1.11; 95% CI 1.03-1.21; P = 0.01) and decreased thrombus progression (RR = 0.26; 95% CI 0.14-0.49; P < 0.0001). Anticoagulation did not significantly influence overall bleeding (RR = 0.78; 95% CI 0.47-1.30; P = 0.34). Early initiation of anticoagulation (RR = 1.58; 95% CI 1.21-2.07; P = 0.0007) significantly increased portal vein recanalization. Child-Pugh class B and C (RR = 0.77; 95% CI 0.62-0.95; P = 0.02) and higher MELD score (MD = - 1.48; 95% CI - 2.20-0.76; P < 0.0001) were significantly associated with decreased portal vein recanalization. No predictor significantly associated with bleeding events was identified. Early initiation of anticoagulation should be supported in liver cirrhosis with PVT. Predictors of portal vein recanalization should be taken into consideration to identify those who may not benefit from anticoagulation. The work was registered in PROSPERO with registration no. CRD42020157142.

Identifiants

DOI: 10.1007/s12325-020-01550-4 PMID: 33155180 PMC: PMC7854392
pubmed: 33155180
doi: 10.1007/s12325-020-01550-4
pii: 10.1007/s12325-020-01550-4
pmc: PMC7854392
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article Meta-Analysis

Langues

eng

Pagination

495-520

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Auteurs

Le Wang (L)

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China.
Postgraduate College, Dalian Medical University, Dalian, China.

Xiaozhong Guo (X)

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China.

Xiangbo Xu (X)

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China.

Valerio De Stefano (V)

Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.

Aurelie Plessier (A)

Hôpital Beaujon, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence Des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche Sur L'Inflammation (CRI), Université Paris 7-Denis-Diderot, ERN Rare Liver Clichy, Paris, France.

Carlos Noronha Ferreira (C)

Serviço de Gastrenterologia E Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.

Xingshun Qi (X)

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China. xingshunqi@126.com.
ORCID: 0000-0002-9448-6739

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Anticoagulation Favors Thrombus Recanalization...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Anticoagulation Favors Thrombus Recanalization...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Fibrose › Cirrhose du foie › Anticoagulation Favors Thrombus Recanalization...
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Veines › Système porte › Veine porte › Anticoagulation Favors Thrombus Recanalization...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thrombose › Anticoagulation Favors Thrombus Recanalization...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thrombose › Thrombose veineuse › Anticoagulation Favors Thrombus Recanalization...