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Thromb Haemost 2021; 121(07): 867-876
DOI: 10.1055/s-0040-1722192
Coagulation and Fibrinolysis

Anticoagulant Treatment for Splanchnic Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Emanuele Valeriani 
1   Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University, Chieti, Italy
2   Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
,
Marcello Di Nisio 
3   Department of Medicine and Ageing Sciences, “G. d'Annunzio” University, Chieti-Pescara, Italy
,
Nicoletta Riva 
4   Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
,
Omri Cohen
5   National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
6   Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Ettore Porreca
1   Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University, Chieti, Italy
,
Marco Senzolo
7   Multivisceral Transplant Unit, University Hospital of Padua, Padua, Italy
,
Andrea De Gottardi
8   Department of Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
,
Marta Magaz
9   Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD. University of Barcelona, Barcelona, Spain
,
Juan-Carlos Garcia-Pagan
9   Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD. University of Barcelona, Barcelona, Spain
,
Walter Ageno
10   Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Abstract

Background Splanchnic vein thrombosis (SVT) is a common complication in patients with liver cirrhosis. The aim of this study was to evaluate the efficacy and safety of anticoagulant therapy for SVT in cirrhotic patients.

Methods In this systematic review and meta-analysis, studies reporting on SVT recanalization and progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were searched in MEDLINE, EMBASE, and ClinicalTrial.gov up to December 2019. Pooled proportions and risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated.

Results A total of 1,475 patients were included in 26 studies (23 observational and 3 randomized controlled trials). In patients receiving anticoagulant therapy, SVT recanalization occurred in 68% (95% CI, 62–74; 571/842 patients; 22 studies), SVT progression in 6% (95% CI, 4–9; 25/748 patients; 22 studies), recurrent VTE in 10% (95% CI, 4–22; 48/399 patients; 7 studies), major bleeding in 6% (95% CI, 4–10; 58/785 patients; 18 studies), and overall mortality in 9% (95% CI, 6–14; 68/787 patients; 17 studies). Anticoagulant treatment was associated with higher SVT recanalization (RR 3.19; 95% CI, 1.42–7.17), lower thrombosis progression (RR 0.28; 95% CI, 0.15–0.52), major bleeding (RR 0.52; 95% CI, 0.28–0.97), and overall mortality (RR 0.42; 95% CI, 0.24–0.73) compared with no treatment.

Conclusion Anticoagulant therapy seems to improve vein recanalization and to reduce SVT progression, major bleeding, and overall mortality in cirrhotic patients with SVT. The incidence of recurrent VTE during anticoagulation remains substantial.

Keywords

anticoagulants - liver cirrhosis - portal vein - splanchnic circulation

Authors' Contributions

Study conception and design: E.V., M.D.N., N.R., W.A.; Data acquisition: E.V., O.C., M.D.N., N.R.; Statistical analysis: E.V., M.D.N., N.R.; Interpretation of the data: All authors; Drafting of the manuscript: E.V., M.D.N., N.R., W.A.; Critical revision of the manuscript for important intellectual content: All authors; Final approval of the manuscript: All authors.


Supplementary Material



Publication History

Received: 22 June 2020

Accepted: 17 November 2020

Article published online:
01 February 2021

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