Anticoagulation in Non-malignant Portal Vein Thrombosis is Safe and Improves Hepatic Function

Overview

Journal Wien Klin Wochenschr

Publisher Springer

Specialty General Medicine

Date 2018 Jun 20

PMID 29916054

Citations 24

Authors

Bernhard Scheiner

Paul Rene Stammet

Sebastian Pokorny

Theresa Bucsics

Philipp Schwabl

Andrea Brichta

Johannes Thaler

Katharina Lampichler

Ahmed Ba-Ssalamah

Cihan Ay

Arnulf Ferlitsch

Michael Trauner

Mattias Mandorfer

Thomas Reiberger

Affiliations

Soon will be listed here.

Abstract

Background: Non-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis.

Aim: We retrospectively assessed the course of non-malignant PVT in patients receiving AC.

Methods: Parameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented.

Results: Among 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (≥9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; p = 0.08) and lower progression rates of 25% (vs. 42% without AC; p = 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (n = 39), long-term AC (n = 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, p = 0.031). Interestingly, AST/ALT tended to decrease (-19%/-16%) and the proportion of patients with ascites became lower (-33%) with long-term AC (without AC: ±0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6 g/dl) when compared to patients without long-term AC (-2%/-0.8 g/dl; p = 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%).

Conclusion: Our findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.

Citing Articles

Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis.

Li H, Yin F, Ma Y, Gao T, Tao Y, Liu X Front Pharmacol. 2025; 15():1462338.

PMID: 39834816 PMC: 11743941. DOI: 10.3389/fphar.2024.1462338.

Direct Oral Anticoagulants Versus Traditional Anticoagulation in Cirrhotic Patients with Portal Vein Thrombosis: Updated Systematic Review.

Xiao X, Zhu W, Dai Q Clin Appl Thromb Hemost. 2024; 30:10760296241303758.

PMID: 39587933 PMC: 11590147. DOI: 10.1177/10760296241303758.

Classification and Management of Portal Vein Thrombosis in Cirrhotic Patients: A Narrative Review.

Alotay A Cureus. 2024; 16(7):e65869.

PMID: 39219865 PMC: 11364363. DOI: 10.7759/cureus.65869.

Effect of Direct Oral Anticoagulants in Patients with Splanchnic Vein Thrombosis: A Systematic Reviews and Meta-Analysis.

Wan Y, Guo L, Xiong M Clin Appl Thromb Hemost. 2024; 30:10760296241274750.

PMID: 39135448 PMC: 11322924. DOI: 10.1177/10760296241274750.

Comparing clinical outcomes of vitamin K antagonists vs non-vitamin K antagonists in anticoagulant therapy for mesenteric venous thrombosis.

Kim Y, Kim H, Park S, Hwang D, Kim H, Huh S J Vasc Surg Venous Lymphat Disord. 2024; 12(5):101903.

PMID: 38754777 PMC: 11523385. DOI: 10.1016/j.jvsv.2024.101903.

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