Direct oral anticoagulants for the treatment of splanchnic vein thrombosis - A systematic review and meta-analysis.
Direct oral anticoagulants
Low-molecular weight heparin
Portal vein thrombosis
Splanchnic vein thrombosis
Thrombosis
Venous thromboembolism
Vitamin-K antagonists
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
11
03
2023
revised:
10
05
2023
accepted:
02
06
2023
pubmed:
7
8
2023
medline:
7
8
2023
entrez:
6
8
2023
Statut:
ppublish
Résumé
Splanchnic vein thrombosis (SVT) is an uncommon manifestation of venous thromboembolism in the splanchnic venous system, with scarce evidence surrounding its management. We assessed the efficacy and safety of direct oral anticoagulant (DOAC) to low-molecular-weight heparins (LMWH), vitamin-k antagonists (VKAs), or no anticoagulation. We conducted a systematic review and meta-analysis with the primary efficacy outcome being complete recanalization of affected vessels and primary safety outcome being major bleeding. Meta-analysis was done using a random-effects model, with dichotomous outcomes being synthesized with odds ratios (ORs) and corresponding 95 % CIs. Seven non-randomized and one randomized study involving 883 participants were included for analysis. DOACs were more effective than VKAs (OR = 4.33; 95 % CI: 2.4, 7.83; n = 1 study) in non-cirrhotic patients and no anticoagulation in cirrhotic patients (OR = 3.86; 95 % CI: 1.49, 10.03; n = 3 studies). DOACs had a statistically significant reduction in major bleeding compared to observation [OR = 0.09; 95 % CI: 0.03, 0.29; n = 3 studies], LMWHs [OR = 0.13; 95 % CI: 0.03, 0.29; n = 1 study] and VKAs [OR = 0.12; 95 % CI: 0.02, 0.69; n = 2 studies] in non-cirrhotic patients. No difference in major bleeding was found between DOACs and observation, LMWH, or VKAs in cirrhotic patients. DOACs appear to be a favorable alternative to VKAs and LMWHs in non-cirrhotic patients. This avenue of research would benefit from larger studies that adjust for SVT etiologies, patient risk factors, and overall bleeding risk.
Sections du résumé
BACKGROUND
BACKGROUND
Splanchnic vein thrombosis (SVT) is an uncommon manifestation of venous thromboembolism in the splanchnic venous system, with scarce evidence surrounding its management. We assessed the efficacy and safety of direct oral anticoagulant (DOAC) to low-molecular-weight heparins (LMWH), vitamin-k antagonists (VKAs), or no anticoagulation.
METHODS
METHODS
We conducted a systematic review and meta-analysis with the primary efficacy outcome being complete recanalization of affected vessels and primary safety outcome being major bleeding. Meta-analysis was done using a random-effects model, with dichotomous outcomes being synthesized with odds ratios (ORs) and corresponding 95 % CIs.
RESULTS
RESULTS
Seven non-randomized and one randomized study involving 883 participants were included for analysis. DOACs were more effective than VKAs (OR = 4.33; 95 % CI: 2.4, 7.83; n = 1 study) in non-cirrhotic patients and no anticoagulation in cirrhotic patients (OR = 3.86; 95 % CI: 1.49, 10.03; n = 3 studies). DOACs had a statistically significant reduction in major bleeding compared to observation [OR = 0.09; 95 % CI: 0.03, 0.29; n = 3 studies], LMWHs [OR = 0.13; 95 % CI: 0.03, 0.29; n = 1 study] and VKAs [OR = 0.12; 95 % CI: 0.02, 0.69; n = 2 studies] in non-cirrhotic patients. No difference in major bleeding was found between DOACs and observation, LMWH, or VKAs in cirrhotic patients.
CONCLUSION
CONCLUSIONS
DOACs appear to be a favorable alternative to VKAs and LMWHs in non-cirrhotic patients. This avenue of research would benefit from larger studies that adjust for SVT etiologies, patient risk factors, and overall bleeding risk.
Identifiants
pubmed: 37544136
pii: S0049-3848(23)00175-5
doi: 10.1016/j.thromres.2023.06.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
209-218Informations de copyright
Copyright © 2023. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of competing interest Mr. Allen Li has received funding from the University of Ottawa and is supported by the American Society of Hematology - 2022 Hematology Opportunities for the Next Generation of Research Scientists (HONORS) Award. Dr. Ali Eshaghpour is supported by the American Society of Hematology - 2023 Hematology Opportunities for the Next Generation of Research Scientists (HONORS) Award. Dr. Marc Carrier has received support from BMS, Leo Pharma, Pfizer, Bayer, Sanofi, Servier, Leo Pharma, BMS, Pfizer and Valeo. Dr. Mark Crowther has received support from AstraZeneca, Bayer, Pfizer, Alynlam, CSL Behring, Precision Biologics, Hemostasis reference laboratories, and Syneos Health. No other authors have relevant conflicts of interests to disclose. No funding was received for the conception and design of this study.