Anticoagulation lowers mortality in patients with cirrhosis, portal vein thrombosis

Treatment with anticoagulants helps improve survival in patients with cirrhosis and portal vein thrombosis independently of recanalization, suggests a study. However, anticoagulation may increase the risk of nonportal hypertension-related bleeding.

A meta-analysis was conducted using individual patient data (IPD) to examine the effect of anticoagulation on all-cause mortality in patients with cirrhosis and portal vein thrombosis. Studies comparing anticoagulants with no treatment were identified from the databases of PubMed, Embase, and Cochrane until June 2020. IPD was requested from the study authors.

The investigators assessed the effect of anticoagulation on all-cause mortality, the primary outcome, through a one-step meta-analysis based on a competing-risk model with liver transplantation as the competing event. They adjusted the model for clinically relevant confounders. Finally, a multilevel mixed-effects logistic regression model was used to determine the effect of anticoagulation on recanalization.

Individual data on 500 patients from five eligible studies were analysed. Of the patients, 205 (41 percent) were treated with anticoagulants and 295 were not.

Anticoagulation resulted in lower all-cause mortality (adjusted subdistribution hazard ratio, 0.59, 95 percent confidence interval [CI], 0.49‒0.70), independently of thrombosis severity and recanalization. Moreover, the effect of anticoagulation on the primary outcome was consistent with a decrease in liver-related deaths.

However, the rate of recanalization was higher in patients who received anticoagulation (adjusted odds ratio, 3.45, 95 percent CI, 2.22‒5.36). Likewise, the nonportal hypertension-related bleeding rate was significantly greater in those treated with anticoagulation.

“According to our findings, portal vein thrombosis may identify a group of patients with cirrhosis that benefit from long-term anticoagulation,” the investigators said.