Safety and Efficacy of Anticoagulation in Patients with Cirrhosis: A Meta-Analysis

Abstract

Background and aims: Portal vein thrombosis is a serious adverse event that occurs during liver cirrhosis. We performed a meta-analysis to evaluate the safety and efficacy of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with (/without) portal vein thrombosis.

Methods: Eligible comparative studies were identified by searching the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI. A meta-analysis was performed to calculate odds ratios and 95% confidence intervals using fixed-effects models. Recanalization and thrombus progression were defined as the primary outcomes. Secondary outcomes included adverse events and death mortality.

Results: A total of 3479 patients were included in this analysis. Compared with the control group, the recanalization rate in the anticoagulant therapy group was increased (P < 0.00001) in patients with cirrhosis and portal vein thrombosis without increasing adverse events. Multiple use of enoxaparin in small doses is safer than single large doses (P=0.004). Direct oral anticoagulants are more effective (P < 0.00001) and safer than traditional anticoagulants. Prophylactic anticoagulant therapy can effectively prevent portal vein thrombosis formation (P < 0.00001).

Conclusions: Anticoagulation therapy can treat or prevent portal vein thrombosis in patients with liver cirrhosis and is a relatively safe treatment.

Figure 1

Flow chart of literature screening.

Figure 2

Bias analysis: (a) A review of the authors' judgments about each risk of bias item presented as percentages; (b) A review of the authors' judgments about each risk of bias item for included studies.

Figure 3

Effect and safety of anticoagulant therapy: (a) analysis of recanalization rate; (b) subgroup analysis of recanalization rate; (c) analysis of thrombus progression or rate of new thrombus formation; (d) bleeding events; (e) other adverse events; (f) mortality rate.

Figure 4

Effect and safety of anticoagulant with different doses of enoxaparin (1.0 mg/kg q 12 h in the experimental group and 1.5 mg/kg qd in the control group): (a) analysis of recanalization rate; (b) bleeding events; (c) other adverse events.

Figure 5

Therapeutic effects of direct oral anticoagulants vs. traditional anticoagulants (Experimental group: direct oral anticoagulant; Control group: traditional oral anticoagulant): (a) analysis of recanalization rate; (b) bleeding events; (c) analysis of bleeding events after random effects were combined; (d) other adverse events; (e) analysis of other adverse events after random effects were combined; (f) analysis of death events after random effects were combined.

Figure 6

Effect and safety of prophylactic anticoagulant: (a) appearance of new thrombosis; (b) subgroup analysis of new thrombosis; (c) bleeding events.

Figure 7

Effect of prophylactic anticoagulation with different drugs.

Figure 8

Effect and safety of anticoagulant combined with traditional Chinese medicine: (a) appearance of thrombosis and preventive effect of anticoagulant on PVT; (b) analysis of PLT; (c) analysis of APTT; (d) analysis of PT.