Fondaparinux superior to LMWH in treatment of portal vein thrombosis in cirrhosis

Fondaparinux (FPX), when used at a reduced dose, seems better than low-molecular-weight heparin (LMWH) in the treatment of portal vein thrombosis as well as complete thrombosis, according to a recent study.

The authors retrospectively included cirrhotic patients with portal vein thrombosis treated with FPX or LMWH and evaluated the extension of thrombosis at baseline and its evolution during anticoagulant treatment. Patients were treated with either FPX or LMWH at therapeutic dosage; reduction was considered in selected cases.

Overall, 124 patients were included, of whom 84 percent, 13 percent, and 36 percent involved the main portal vein branch, splenic, and superior mesenteric veins, respectively. Majority of the patients were treated with LMWH (n=83, 67 percent) and the rest FPX (n=49, 33 percent).

Patients on FPX had a significantly higher probability of resolution of thrombosis than those treated with LMWH (77 percent vs 51 percent; p=0.001), particularly when prescribed at reduced dose.

In multivariate analysis, treatment with FPX (hazard ratio, 2.38; p=0.001) and use of a full dose (hazard ratio, 1.78; p=0.035) were independently predictive of portal vein full recanalization. In addition, bleeding rate was higher in patients treated with FPX than in those on LMWH (27 percent vs 13 percent; p=0.06).

“FPX should be considered among possible treatments for portal vein thrombosis in cirrhosis,” the authors said.

“Portal vein thrombosis is the most common thrombotic complication in cirrhosis. About 60 percent of anticoagulated patients can achieve recanalization,” they noted.