Anticoagulation for Portal Vein Thrombosis in Patients with Cirrhosis

Authors: Pettinari I et al.

Am J Gastroenterol 2018 Dec 11

Prior studies have shown that anticoagulation is indicated for noncirrhotic patients with portal vein thrombosis (PVT), but the efficacy and safety of anticoagulation for cirrhotic patients with PVT is unclear.

To address this issue, investigators in Italy and Romania conducted a retrospective study of 182 cirrhotic patients who received a diagnosis of nonmalignant PVT between 2008 and 2016 and were followed for at least 3 months. Of these, 81 received anticoagulation therapy; 56 received low-molecular-weight heparin, 15 received fondaparinux, and 10 received oral anticoagulants. The remaining 101 patients were untreated. Most patients had hepatitis C infection or were alcoholic, and 17% had hepatocellular carcinoma. Those receiving anticoagulation underwent upper endoscopy prior to initiating therapy, and high-risk varices were treated with band ligation or beta-blocker therapy.

At a median follow-up of 19 months (range, 3 to 94 months), patients treated with anticoagulation had higher PVT recanalization rates than untreated patients (56.8% vs. 25.7%; P<0.0001), as well as improved survival independent of degree of liver dysfunction (median 70 vs. 59 months; P=0.01), and lower rates of transplantation (7.4% vs. 17.8%; P=0.0476). Bleeding rates were similar with or without treatment (19.7% and 21.8%, respectively).