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. 2019 Sep;64(9):2671-2683.
doi: 10.1007/s10620-019-05572-z. Epub 2019 Mar 9.

Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis

Carlos Noronha Ferreira  1 , Daniela Reis  2 , Helena Cortez-Pinto  2 , Rui Tato Marinho  2 , Afonso Gonçalves  3 , Sónia Palma  3 , Inês Leite  3 , Tiago Rodrigues  3 , Ana Júlia Pedro  4 , Paula Alexandrino  2 , Fátima Serejo  2 , Margarida Sobral Dias  2 , Paula Ferreira  2 , Mariana Vasconcelos  2 , Filipe Damião  2 , Leonor Xavier Brito  2 , Cilenia Baldaia  2 , Narcisa Fatela  2 , Fernando Ramalho  2 , José Velosa  2
Affiliations

Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis

Carlos Noronha Ferreira et al. Dig Dis Sci. 2019 Sep.

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.

Keywords: Anticoagulation; Cirrhosis; Orthotopic liver transplantation; Portal vein thrombosis; Prognosis; Rethrombosis.

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