Clinical question: Should patients with liver cirrhosis with portal vein thrombosis be treated with anticoagulation?
Background: Portal vein thrombosis occurs in about 20% of patients with liver cirrhosis. Previously these patients were not often treated with anticoagulation due to concern for increased bleeding risk associated with advanced liver disease. However, restoring portal vein patency may prevent further sequelae, including intestinal infarction and portal hypertension and may also affect candidacy for liver transplantation.
Setting: Multiple sites throughout the world.
Synopsis: The authors of this meta-analysis pooled data from eight clinical trials, comprising 353 patients with liver cirrhosis and portal vein thrombosis, to assess the rates of complete and partial recanalization with anticoagulation therapy (warfarin or low molecular weight heparin) versus no therapy. The authors also assessed the rate of minor and major bleeding complications in patients who received anticoagulation, compared with those who received no therapy. Patients who received anticoagulation therapy had increased recanalization and reduced progression of thrombosis without excessive major and minor bleeding.
Bottom line: This meta-analysis suggests anticoagulation might be safe and effective in treating portal vein thrombosis in patients with cirrhosis; however, this analysis was based on nonrandomized clinical trials and did not address long-term important endpoints, such as the effect of anticoagulation on mortality.
Citation: Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: A systematic review and meta-analysis. Gastroenterology. 2017 May 4. E-published ahead of print.
Dr. Teixeira is a hospitalist at Ochsner Health System, New Orleans.