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Meta-Analysis
. 2025 Jun;45(6):e70114.
doi: 10.1111/liv.70114.

Safety of Anticoagulant Treatment in Patients With Splanchnic Vein Thrombosis and History of Portal Hypertension-Related Bleeding

Rosa Talerico  1 , Simona Pellegrino  1 , Aurélie Plessier  2 , Francesca Romana Ponziani  3 , Angelo Porfidia  1 , Francesco Landi  1 , Antonio Gasbarrini  3 , Roberto Pola  1 , Francesco Santopaolo  3
Affiliations
Meta-Analysis

Safety of Anticoagulant Treatment in Patients With Splanchnic Vein Thrombosis and History of Portal Hypertension-Related Bleeding

Rosa Talerico et al. Liver Int. 2025 Jun.

Abstract

Splanchnic vein thrombosis (SVT) can be associated with liver cirrhosis or prothrombotic conditions, including myeloproliferative disorders, intra-abdominal inflammation, solid cancers or surgery. While anticoagulation therapy improves outcomes in noncirrhotic patients and reduces all-cause mortality in cirrhotic populations, its safety in patients with a history of portal hypertension (PH)-related bleeding is less clear. This systematic review examines the impact of anticoagulant therapy on rebleeding risk in SVT patients with a history of PH-related bleeding. A systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive search of PubMed, Web of Science and Scopus was performed for studies published up to September 2024. Studies were included if they compared SVT patients with a history of PH-related bleeding receiving anticoagulant therapy versus those not receiving anticoagulants. The primary outcome was the cumulative incidence of PH-related rebleedings. Of 2853 identified studies, five (186 participants) met the inclusion criteria: two randomised controlled trials (RCTs) and three observational studies. The cumulative incidence of PH-related rebleeding was significantly lower in the anticoagulant group at 17.10% [95% CI 17.02, 17.19] compared to the control group at 40.00% [95% CI 39.90, 40.09]. The overall odds ratio (OR) from observational studies was 0.15 [95% CI 0.04, 0.52], indicating a reduced bleeding risk, while the OR from RCTs was 0.84 [95% CI 0.31, 2.32], showing a nonsignificant trend. Anticoagulant therapy may reduce rebleeding risk in SVT patients with a history of PH-related bleeding, but further high-quality studies are needed.

Keywords: bleeding history; portal hypertension‐related bleeding; splanchnic vein thrombosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Prisma flowchart that represents the step‐by‐step process to analyse literature for the meta‐analysis. Abbreviations: NR (not reported).
FIGURE 2
FIGURE 2
PH rebleeding between AC group versus control group in patients with SVT and a history of PH‐related bleeding (random‐effects model) in the NRSs (above) and RCTs (below). Abbreviations: AC (anticoagulant group), C (control group), CI (confidence interval), NRSs (Nonrandomised Studies), PH (portal hypertension), RCTs (randomised controlled trials), SVT (splanchnic vein thrombosis).
See this image and copyright information in PMC

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