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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Gastrointestinal and Hepatic Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1462338

Administration of Anticoagulation Strategies for Portal Vein Thrombosis in Cirrhosis: Network Meta-Analysis

Provisionally accepted
Hui-Jun Li Hui-Jun Li 尹 富强 尹 富强 Yu-Tong Ma Yu-Tong Ma Teng-Yu Gao Teng-Yu Gao Yu-Ting Tao Yu-Ting Tao Xin Liu Xin Liu Xianfeng Shen Xianfeng Shen Chao Zhang Chao Zhang *
  • Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China

The final, formatted version of the article will be published soon.

    Objectives: Evidences for anticoagulation strategies in cirrhotic with portal vein thrombosis (PVT) are still insufficient. This study aims to comprehensively compare the therapeutic effects of different therapeutic therapeutic measures in individuals suffering from cirrhosis with PVT, with the ultimate goal of providing evidence-based recommendations for thrombolytic therapy in this population. Methods: Starting from October 20, 2023, a comprehensive search about therapeutic strategies for portal vein thrombosis in cirrhosis was conducted on PubMed, EMBASE, and Cochrane Library. Results: 19 studies were eventually incorporated into this study. Comparison with control in network meta-analysis, direct oral anticoagulants (DOACs) (RR=2.15, 95%CI: 1.33, 3.48), LMWH (RR=1.41, 95%CI: 1.01, 1.99), TIPS (RR=5.68, 95%CI: 2.63, 12.24), warfarin (RR=2.16, 95%CI: 1.46, 3.21), EBL plus propranolol (RR=2.80, 95%CI: 1.18, 6.60), LMWH-DOACs sequential (RR=7.92, 95%CI: 2.85, 21.99) and LMWH-warfarin sequential (RR=2.26, 95%CI: 1.16, 4.42) significantly improved the incidence of complete recanalization. The anticoagulation drugs were ranked based on their SUCRA values, with the LMWH-DOACs sequential (92.7%), TIPS plus warfarin (91.3%), and TIPS (80.3%) emerging as the top three effective treatments. Conclusion: In this study, active anticoagulants were recommended for cirrhosis with PVT. The TIPS plus warfarin, LMWH-DOACs sequential, and TIPS improved the complete recanalization rate most effectively, and the EBL plus propranolol, heparin plus DOACs plus warfarin, and DOACs were highly recommended for increasing the incidence of partial recanalization. Warfarin and TIPS were recommended for reducing the frequency of bleeding events, while LMWH plus warfarin and DOACs proved to be most effective in decreasing the rate of major bleeding events. Warfarin, heparin plus DOACs plus warfarin, and DOACs demonstrated the most significant reduction in mortality rates, highlighting its potential as an effective intervention. TIPS plus warfarin, LMWH-DOACs sequential, and TIPS were recommended for reducing the occurrence of PVT expansion. Heparin plus DOACs plus warfarin was recommended for reducing the occurrence of hepatic encephalopathy, and protocols that involve TIPS were generally associated with a higher risk of hepatic encephalopathy. However, a longer follow-up period is necessary to comprehensively evaluate the efficacy of active anticoagulants therapy in patients with PVT in cirrhosis.

    Keywords: Portal vein thrombosis, cirrhosis, direct oral anticoagulants, Transjugular intrahepatic portosystemic shunt, low molecular weight heparin, Warfarin

    Received: 10 Jul 2024; Accepted: 09 Dec 2024.

    Copyright: © 2024 Li, 富强, Ma, Gao, Tao, Liu, Shen and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Chao Zhang, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China

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