Anticoagulant use linked to better PVT outcomes in cirrhosis patients

Last Updated: 2017-05-22

By Anne Harding

NEW YORK (Reuters Health) - Use of anticoagulant drugs is associated with improved recanalization and slower progression of portal vein thrombosis (PVT) in cirrhosis patients, as well as to a reduced risk of variceal bleeding, according to a new systematic review and meta-analysis.

“It’s a very provocative paper in the context of liver cirrhosis,” Dr. Francesco Violi of Sapienza University in Rome, one of the study’s authors, told Reuters Health in a telephone interview. There is a perception that patients with cirrhosis have coagulopathy, he explained, making it risky to treat them with anticoagulants.

Up to half of patients with cirrhosis develop PVT, which is an indicator of poor outcome, Dr. Violi and his team note in their report, online May 4 in Gastroenterology. They compared recanalization and progression of PVT in patients with cirrhosis who were on anticoagulants compared to those who were not, and also looked at variceal and non-variceal bleeding.

The review included eight studies, none of which was randomized, and 353 patients. Among patients on anticoagulants, 71% underwent recanalization, versus 42% of those on no therapy. Based on six studies, PVT recanalization was complete in 53% of patients on anticoagulants and 33% of untreated patients (p=0.002).

PVT progression occurred in 9% of patients on anticoagulants versus 33% of those on no treatment (p<0.0001).

In the six studies that reported bleeding, the rate of major or minor bleeding was 11% in both groups. Patients on anticoagulants were significantly less likely to have spontaneous variceal bleeding (2% versus 12%).

“This is consistent with a previous report in non-cirrhotic PVT showing that anticoagulants protected against variceal bleeding; the authors suggested that thrombosis reduction could limit blood pressure increase in the portal circulation and eventually prevent variceal rupture,” the researchers note.

Clinicians should always check for PVT in their patients with cirrhosis, Dr. Violi said, pointing out that it is asymptomatic in 40% of cases. Patients can be treated with warfarin or low molecular weight heparin, he added, but newer anticoagulants should be avoided given concerns that they are associated with GI bleeding.

In his own practice, Dr. Violi added, he prescribes warfarin to treat PVT.

“This paper suggests the potential usefulness of this approach, but we need randomized clinical trials,” he said. More research also needs to be done to understand the mechanism of disease in PVT, he added, which could lead to strategies for preventing it in at-risk patients.

SOURCE: http://bit.ly/2qGU7fQ

Gastroenterology 2017.