Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis

• Published in: Digestive diseases and sciences 2019-09, Vol.64 (9), p.2671-2683
• Main Authors: Noronha Ferreira, Carlos, Reis, Daniela, Cortez-Pinto, Helena, Tato Marinho, Rui, Gonçalves, Afonso, Palma, Sónia, Leite, Inês, Rodrigues, Tiago, Pedro, Ana Júlia, Alexandrino, Paula, Serejo, Fátima, Sobral Dias, Margarida, Ferreira, Paula, Vasconcelos, Mariana, Damião, Filipe, Xavier Brito, Leonor, Baldaia, Cilenia, Fatela, Narcisa, Ramalho, Fernando, Velosa, José
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants; Anticoagulants (Medicine); Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Biochemistry; Blood clot; End Stage Liver Disease - etiology; End Stage Liver Disease - surgery; Female; Gastroenterology; Hemorrhage - chemically induced; Heparin, Low-Molecular-Weight - therapeutic use; Hepatology; Humans; Hypertension; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Liver Transplantation; Liver transplants; Male; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Molecular weight; Mortality; NMR; Nuclear magnetic resonance; Oncology; Original Article; Patients; Portal Vein; Prognosis; Proportional Hazards Models; Recurrence; Retrospective Studies; Severity of Illness Index; Studies; Survival Rate; Systematic review; Thrombosis; Thrombosis - drug therapy; Thrombosis - etiology; Transplant Surgery; Transplantation of organs, tissues, etc; Transplants & implants; Ultrasonic imaging; Warfarin - therapeutic use
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05572-z

Background The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. Aims We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival. Methods Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis. Results Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p  = 0.005]. OLT-free survival after a median follow-up of 25 (1–146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not ( p  = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01–1.21, p  = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05–1.19, p