Objective

To evaluate the efficacy and safety of anticoagulant therapy in patients with cirrhotic PVT, and compare differences in efficacy and safety among different anticoagulants.

Methods

We comprehensively searched Pubmed, Cochrane Library, EMBASE, and ClinicalTrials.gov from inception to April 2022 for studies using anticoagulants for cirrhotic PVT. Meta-analysis was performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

Results

3 RCTs and 14 cohort studies involving 1270 patients were included. Anticoagulant therapy can increase the recanalization rate compared with non-anticoagulation therapy (OR 4.44, 95% CI 3.11-6.32, I² = 2.5%) and can decrease the extension rate of cirrhotic PVT (OR 0.33, 95% CI 0.18-0.62, I² = 41.0%), without increasing the incidence of total bleeding (OR 1.21, 95% CI 0.75-1.97, I² = 9.8%), major bleeding (OR 0.98, 95% CI 0.49-1.95, I² = 19.7%), and variceal bleeding (OR 0.35, 95% CI 0.12-1.01, I² = 39.9%). Subgroup analysis showed that VKA, LMWH, and DOACs could increase the recanalization rate of PVT and were not associated with the risk of bleeding. Studies that compared direct oral anticoagulants (DOACs) with warfarin directly showed that the recanalization rate of PVT in the DOACs group might be higher than that in the warfarin group (OR 30.99, 95% CI 7.39-129.87, I² = 0.0%), and there was no difference in the rate of total bleeding (OR 0.30, 95% CI 0.01-8.65, I² = 79.6%).

Conclusions

Anticoagulants are safe and effective in patients with cirrhotic PVT. The rate of PVT recanalization associated with DOACs may be higher than warfarin.

中文翻译：

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抗凝剂治疗肝硬化门静脉血栓的疗效和安全性：系统评价和荟萃分析

客观的

评价肝硬化PVT患者抗凝治疗的疗效和安全性，比较不同抗凝剂的疗效和安全性差异。

方法

我们全面搜索了 Pubmed、Cochrane 图书馆、EMBASE 和 ClinicalTrials.gov 从开始到 2022 年 4 月使用抗凝剂治疗肝硬化 PVT 的研究。进行 Meta 分析以计算具有 95% 置信区间 (CI) 的优势比 (OR)。

结果

纳入了 3 项 RCT 和 14 项队列研究，涉及 1270 名患者。与非抗凝治疗相比，抗凝治疗可提高再通率（OR 4.44, 95% CI 3.11-6.32, I ²  = 2.5%），可降低肝硬化PVT的延长率（OR 0.33, 95% CI 0.18-0.62, I ²  = 41.0%），不增加总出血发生率（OR 1.21，95% CI 0.75-1.97，I ²  = 9.8%），大出血（OR 0.98，95% CI 0.49-1.95，I ²  = 19.7% ) 和静脉曲张出血 (OR 0.35, 95% CI 0.12-1.01, I ² = 39.9%）。亚组分析显示，VKA、LMWH 和 DOACs 可增加 PVT 的再通率，且与出血风险无关。直接比较直接口服抗凝剂（DOACs）与华法林的研究表明，DOACs组的PVT再通率可能高于华法林组（OR 30.99，95% CI 7.39-129.87，I ²  = 0.0%），总出血率无差异（OR 0.30，95% CI 0.01-8.65，I ²  = 79.6%）。

结论

抗凝剂对肝硬化 PVT 患者安全有效。与 DOAC 相关的 PVT 再通率可能高于华法林。