Erschienen in:
09.03.2019 | Original Article
Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis
verfasst von:
Carlos Noronha Ferreira, Daniela Reis, Helena Cortez-Pinto, Rui Tato Marinho, Afonso Gonçalves, Sónia Palma, Inês Leite, Tiago Rodrigues, Ana Júlia Pedro, Paula Alexandrino, Fátima Serejo, Margarida Sobral Dias, Paula Ferreira, Mariana Vasconcelos, Filipe Damião, Leonor Xavier Brito, Cilenia Baldaia, Narcisa Fatela, Fernando Ramalho, José Velosa
Erschienen in:
Digestive Diseases and Sciences
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Ausgabe 9/2019
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Abstract
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 < 0.001).
Conclusions
Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.