Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis

Sami Ghazaleh; Azizullah Beran; Kanana Aburayyan; Christian Nehme; Dipen Patel; Yasmin Khader; Sachit Sharma; Muhammad Aziz; Yousef Abdel-Aziz; Tariq Hammad; Ali Nawras

Authors Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz, Yousef Abdel-Aziz, Tariq Hammad, Ali Nawras.

Abstract

Background The role of anticoagulation in treating non-malignant portal vein (PV) thrombosis (PVT) in patients with liver cirrhosis remains unclear. In our meta-analysis, we aimed to evaluate the efficacy and safety of anticoagulation for the treatment of non-malignant PVT in these patients.

Methods We conducted a meta-analysis to estimate the effects of anticoagulation on nonmalignant PVT in patients with liver cirrhosis. We assessed the rates of PV recanalization, variceal bleeding, and any bleeding.

Results We included 9 observational studies which involved 474 patients. The rate of PV recanalization was significantly higher in patients who received anticoagulation compared to those who did not: 65.2% vs. 25.2%; relative risk (RR) 2.31, 95% confidence interval (CI) 1.80-2.96; P<0.00001. Variceal bleeding was significantly lower in patients who received anticoagulation: 0.1% vs. 18.5%; RR 0.15, 95%CI 0.04-0.55; P=0.004. Any bleeding was similar between patients who received anticoagulation and those who did not: 10.3% vs. 22.7%; RR 0.43, 95%CI 0.09-1.99; P=0.28.

Conclusions Anticoagulation use increased the rate of PV recanalization in cirrhotic patients with non-malignant PVT. Anticoagulation decreased the rate of variceal bleeding and did not increase the rate of any bleeding.

Keywords Warfarin, heparin, portal vein recanalization, bleeding

Ann Gastroenterol 2021; 34 (1): 104-110