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Anticoagulant Therapy for Splanchnic Vein Thrombosis in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

1“G. d'Annunzio” University, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy, 2“G. d'Annunzio” University, Department of Medicine and Ageing Sciences, Chieti, Italy, 3University of Malta, Department of Pathology, Faculty of Medicine and Surgery, Msida, Malta, 4Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, National Hemophilia Center, Tel-Hashomer, Israel, 5Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel, 6University Hospital of Padua, Multivisceral Transplant Unit,, Padua, Italy, 7Università della Svizzera Italiana, Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Lugano, Switzerland, 8University of Barcelona, Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, Barcelona, Spain, 9University of Insubria, Department of Medicine and Surgery, Varese, Italy

Abstract Number: PB2442

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment

Background: The clinical course of patients with liver cirrhosis may be complicated by the occurrence of splanchnic vein thrombosis (SVT). Anticoagulant treatment for these patients is challenging due to the increased risk of gastrointestinal bleeding of cirrhotic patients.

Aims: In this systematic review and meta-analysis, we evaluated the efficacy and safety of anticoagulation in cirrhotic patients with SVT.

Methods: Studies reporting the rate of SVT recanalization and progression, recurrent VTE, major bleeding, and overall mortality were searched through MEDLINE, EMBASE, and clinicaltrial.gov up to December 2019. Pooled proportion and risk ratio (RR) with corresponding 95% confidence intervals (CI) were calculated using a random-effects model.

Results: A total of 1,609 patients were included in 27 studies (24 observational studies and 3 randomized controlled trials). In patients receiving anticoagulant therapy, the rate of partial or complete SVT recanalization was 71% (95% CI, 64-77), the rate of SVT progression was 6% (95% CI, 4-8), and the rate of recurrent VTE was 11% (95% CI, 5-22). Major bleeding occurred in 8% (95% CI, 5-11) and overall mortality in 9% (95% CI, 5-14) of patients.
In patients who remained untreated, the rates of SVT recanalization, SVT progression, recurrent VTE, major bleeding, and overall mortality were 26% (95% CI, 9-54), 24% (95% CI, 9-53), 15% (95% CI, 8-26), 16% (95% CI, 12-21), and 22% (95% CI, 15-33), respectively. The rate of SVT recanalization (RR 3.06; 95% CI, 1.28-7.32) was significantly higher while the rates of thrombosis progression (RR 0.24; 95% CI, 0.12-0.51) and major bleeding (RR 0.66; 95% CI, 0.45-0.96) were significantly lower in patients receiving anticoagulation compared with untreated patients.

Conclusions: Anticoagulant therapy seems to improve SVT recanalization and to reduce SVT progression without increasing the risk of major bleeding. The incidence of recurrent VTE during anticoagulation remains substantial.

To cite this abstract in AMA style:

Valeriani E, Di Nisio M, Riva N, Cohen O, Porreca E, Senzolo M, De Gottardi A, Magaz M, Garcia-Pagan J-, Ageno W. Anticoagulant Therapy for Splanchnic Vein Thrombosis in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulant-therapy-for-splanchnic-vein-thrombosis-in-patients-with-liver-cirrhosis-a-systematic-review-and-meta-analysis/. Accessed January 23, 2022.

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