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Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis
INTRODUCTION: 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 antico...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Healthcare
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854392/ https://www.ncbi.nlm.nih.gov/pubmed/33155180 http://dx.doi.org/10.1007/s12325-020-01550-4 |
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author | Wang, Le Guo, Xiaozhong Xu, Xiangbo De Stefano, Valerio Plessier, Aurelie Noronha Ferreira, Carlos Qi, Xingshun |
author_facet | Wang, Le Guo, Xiaozhong Xu, Xiangbo De Stefano, Valerio Plessier, Aurelie Noronha Ferreira, Carlos Qi, Xingshun |
author_sort | Wang, Le |
collection | PubMed |
description | INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. REGISTRATION: The work was registered in PROSPERO with registration no. CRD42020157142. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12325-020-01550-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7854392 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-78543922021-02-08 Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis Wang, Le Guo, Xiaozhong Xu, Xiangbo De Stefano, Valerio Plessier, Aurelie Noronha Ferreira, Carlos Qi, Xingshun Adv Ther Original Research INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. REGISTRATION: The work was registered in PROSPERO with registration no. CRD42020157142. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12325-020-01550-4) contains supplementary material, which is available to authorized users. Springer Healthcare 2020-11-05 2021 /pmc/articles/PMC7854392/ /pubmed/33155180 http://dx.doi.org/10.1007/s12325-020-01550-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Original Research Wang, Le Guo, Xiaozhong Xu, Xiangbo De Stefano, Valerio Plessier, Aurelie Noronha Ferreira, Carlos Qi, Xingshun Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title | Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title_full | Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title_fullStr | Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title_full_unstemmed | Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title_short | Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis |
title_sort | anticoagulation favors thrombus recanalization and survival in patients with liver cirrhosis and portal vein thrombosis: results of a meta-analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854392/ https://www.ncbi.nlm.nih.gov/pubmed/33155180 http://dx.doi.org/10.1007/s12325-020-01550-4 |
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