Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function.

Abstract

BACKGROUND:

Non-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis.

AIM:

We retrospectively assessed the course of non-malignant PVT in patients receiving AC.

METHODS:

Parameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented.

RESULTS:

Among 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (≥9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; p = 0.08) and lower progression rates of 25% (vs. 42% without AC; p = 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (n = 39), long-term AC (n = 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, p = 0.031). Interestingly, AST/ALT tended to decrease (-19%/-16%) and the proportion of patients with ascites became lower (-33%) with long-term AC (without AC: ±0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6 g/dl) when compared to patients without long-term AC (-2%/-0.8 g/dl; p = 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%).

CONCLUSION:

Our findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.

• Authors: Bernhard Scheiner, Paul René Stammet, Sebastian Pokorny, Theresa Bucsics, Philipp Schwabl, Andrea Brichta, Johannes Thaler, Katharina Lampichler, Ahmed Ba-Ssalamah, Cihan Ay, Arnulf Ferlitsch, Michael Trauner, Mattias Mandorfer, Thomas Reiberger
• Journal: Wiener klinische Wochenschrift (Wien Klin Wochenschr) Vol. 130 Issue 13-14 Pg. 446-455 (Jul 2018) ISSN: 1613-7671 [Electronic] Austria
• PMID: 29916054 (Publication Type: Journal Article)

Chemical References

• Anticoagulants

Topics

• Anticoagulants (therapeutic use)
• Esophageal and Gastric Varices
• Female
• Gastrointestinal Hemorrhage
• Humans
• Kidney (drug effects, physiology)
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Portal Vein
• Retrospective Studies
• Venous Thrombosis (drug therapy)