Abstract

ANTICOAGULATION TREATMENT FOR PORTAL VEIN THROMBOSIS IN PATIENTS WITH CIRRHOSIS: WHICH CLASS OF DRUGS IS PREFERRED?

*Ouiam Elmqaddem, Meryem Nasiri, Noura Kennoudi, Amine Bouazzaoui, Naima Abda, Hajar Koulali, Abdelkrim Zazour, Ghizlane Kharrasse and My. Zahi Ismaili

.

Abstract

Background: The management of portal vein thrombosis (PVT) in patients with cirrhosis is problematic due to the deterioration of liver function and pre-existing hemostatic disorders. There are numerous anticoagulant treatments available. However, there is little evidence indicating which one is associated with better recanalization rate, lower bleeding risk and better prognosis in the context of cirrhosis. Direct oral anticoagulant (DOAC) and low molecular weight heparin (LMWH) were the two drugs compared in the study. Aim: To compare the recanalization rate, bleeding risk, and prognosis in patients with PVT and cirrhosis treated with DOAC or LMWH. Methods: This retrospective cohort study identified patients diagnosed with cirrhosis and acute PVT between January 2015 and August 2022. The variables studied were recanalization, bleeding risk, and prognosis. Among the 200 consecutive patients, 53 patients with cirrhosis and nonmalignant PVT were retrospectively included. Doppler ultrasound and computed tomography scan were performed at baseline. Doppler ultrasound was repeated every 6 mo or when clinically indicated. Recanalization was confirmed by computed tomography scan. Treatment was decided on a case-by-case basis and was dependent on the stage of liver disease, patient age, and extension of thrombus. The statistical analysis was performed using SPSS software. Results: There were no significant differences in the clinical characteristics of patients in the LMWH group, the DOAC group, and the non-treated group. In the non-treated group, the recanalization rate and prognosis improvement were low compared to the groups treated with anticoagulants. In the subgroup analysis of the DOAC and LMWH groups, there were no significant differences in the recanalization rate, bleeding risk, nor prognosis improvement. Conclusion: According to our analysis and literature review, there is still insufficient data to recommend a particular therapeutic class of anticoagulant treatment in patients with cirrhosis and PVT. Further research including a larger cohort of patients is needed.

Keywords: Thrombosis; Low molecular weight heparin; Direct-acting oral anticoagulant; Warfarin; Cirrhosis.