Abstract:

Objective To investigate the efficacy and safety of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with or without portal vein thrombosis (PVT). Methods Literature searchs were conducted using PubMed, Cochrane, Embase, Web of Science, CNKI, Wanfang, and VIP databases, and relevant references were also reviewed. The included literatures were assessed for quality and data extraction. A meta-analysis was conducted using Revman5.3 and Stata14.0. Results Twenty-three eligible articles were included in 3423 retrieved articles. In patients with cirrhosis and PVT, the PVT recanalization rate in the anticoagulant therapy group was significantly higher than that of the non-anticoagulant group (OR=3.39, 95%CI: 2.59-4.44, P<0.001), without an increase in adverse events. The PVT recanalization rate of direct oral anticoagulants (DOAC) was significantly higher than that of traditional anticoagulants (OR=39.49, 95%CI: 9.65-161.68, P<0.001), and the rate of major bleeding was significantly lower than that of traditional anticoagulants (OR=0.35, 95%CI: 0.13-0.97, P=0.04). In patients with cirrhosis without PVT, the rate of PVT formation in the prophylactic anticoagulation group was significantly lower than that of non-anticoagulant group (OR=0.15, 95%CI: 0.05-0.43, P<0.001), with no difference of bleeding between groups (OR=1.96, 95%CI: 0.72-5.30, P=0.19), but the all-cause mortality rate in the prophylactic anticoagulation group was significantly lower (OR=0.51, 95%CI: 0.43-0.60, P<0.001). Conclusion Anticoagulant therapy can treat or prevent PVT in patients with cirrhosis and is a relatively safe treatment.

Key words: liver cirrhosis, anticoagulation, prophylactic anticoagulation, portal vein thrombosis, meta-analysis