Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis:
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ORIGINAL RESEARCH
Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a MetaAnalysis Le Wang . Xiaozhong Guo . Xiangbo Xu . Valerio De Stefano . Aurelie Plessier . Carlos Noronha Ferreira . Xingshun Qi
Received: September 23, 2020 / Accepted: October 23, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Benefit and risk of anticoagulation in cirrhotic patients with portal vein thrombosis (PVT) remain controversial, especially in those with asymptomatic PVT and in non-liver transplant candidates. Furthermore, the predictors of portal vein recanalization and bleeding events after anticoagulation are critical for making clinical decisions, but still unclear. We conducted a meta-analysis to investigate the
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12325020-01550-4) contains supplementary material, which is available to authorized users. L. Wang X. Guo X. Xu X. Qi (&) Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China e-mail: [email protected] L. Wang Postgraduate College, Dalian Medical University, Dalian, China V. De Stefano Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
outcomes of anticoagulation for PVT in liver cirrhosis and explore the predictors of portal vein recanalization and bleeding events after anticoagulation. Methods: All studies regarding anticoagulation for PVT in liver cirrhosis were searched via PubMed, EMBASE, and Cochrane Library databases. Thrombotic outcomes, bleeding events, and survival were compared between anticoagulation and non-anticoagulation groups. Predictors of portal vein recanalization and bleeding events were pooled. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Thirty-three studies including 1696 cirrhotic patients with PVT were included. Anticoagulation significantly increased portal
A. Plessier ˆ pital Beaujon, AP-HP, DHU Unity, Po ˆ le des Ho Maladies de l’Appareil Digestif, Service d’He´patologie, Centre de Re´fe´rence Des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche Sur L’Inflammation (CRI), Universite´ Paris 7-Denis-Diderot, ERN Rare Liver Clichy, Paris, France C. Noronha Ferreira Servic¸o de Gastrenterologia E Hepatologia, Hospital de Santa Maria—Centro Hospitalar Universita´rio Lisboa Norte, Lisboa, Portugal
Adv Ther
vein recanalization (RR = 2.61; 95% CI 1.99–3.43; P \ 0.00001) and overall survival (RR = 1.11; 95% CI 1.03–1.21; P = 0.01) and decreased thrombus progression (RR = 0.26; 95% CI 0.14–0.49; P \ 0.0001). Anticoagulation did not significantly influence overall bleeding (RR = 0.78; 95% CI 0.47–1.30; P = 0.34). Early initiation of anticoagulation (RR = 1.58; 95% CI 1.21–2.07; P = 0.0007) significantly increas
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