Anticoagulation is Likely Beneficial for Portal Vein Thrombosis in Cirrhosis

by Joseph Esherick, M.D., FAAFP, FHM

The optimal treatment of portal vein thrombosis in patients with cirrhosis has been a topic of debate for quite some time.  To this date there have been no large prospective, randomized controlled trials to help guide management in these patients.  Anticoagulation of patients with cirrhosis and portal vein thrombosis (PVT) has been shown to lead to portal vein recanalization; however, bleeding has always been a concern.

This systematic review and meta-analysis assessed the outcomes of anticoagulation in 353 patients with cirrhosis and PVT. The primary outcome was recanalization and progression of PVT. Eight studies (5 retrospective, 2 prospective, 1 randomized, controlled trial) were included in which patients were treated with low-weight heparin or warfarin anticoagulation or no anticoagulation.

Any PVT recanalization (complete or partial) occurred more frequently in the anticoagulated group compared with the untreated group (71% vs. 42%), as did complete recanalization (53% vs. 33%; based on 6 studies comprising 217 patients). PVT progression occurred less frequently in the anticoagulated group (9% vs. 33%; based on six studies comprising 225 patients). The occurrence of any type of bleeding was similar among groups (11% in each). Among four studies comprising 158 patients, variceal bleeding occurred at a lower rate in anticoagulated versus untreated patients (2% vs. 12%).  The lower rate of variceal bleeding was felt to be due to lower portal pressures in the anticoagulated group.

Liver failure with portal vein thrombosis

Loffredo L et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: A systematic review and meta-analysis. Gastroenterology 2017 May 4