Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: A systematic review and meta-analysis.
Dig Liver Dis
; 54(1): 56-62, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-34393072
ABSTRACT
INTRODUCTION AND AIM:
Portal vein thrombosis (PVT) is associated with a higher risk of liver-related complications. Recent guidelines recommend direct-acting anticoagulants (DOAC) in patients with cirrhosis and non-tumoral PVT. However, data on the efficacy and safety of DOAC in these patients remain limited. We aim to investigate the efficacy and safety of DOAC compared to vitamin K antagonists (VKA) to treat non-tumoral PVT in patients with cirrhosis.METHODS:
We performed a systematic search of six electronic databases using MeSH term and free text. We selected all studies comparing the use of DOACs with vitamin K antagonist to treat PVT in cirrhosis. The primary outcome was PVT recanalization. Secondary outcomes were and PVT progression, major bleeding, variceal bleeding and death.RESULTS:
From 944 citations, we included 552 subjects from a total of 11 studies (10 observational and 1 randomized trial) that fulfilled the inclusion criteria. We found that DOAC were associated with a higher pooled rate of PVT recanalization (RR = 1.67, 95%CI 1.02, 2.74, I2 = 79%) and lower pooled risk of PVT progression (RR = 0.14, 95%CI 0.03-0.57, I2 = 0%). The pooled risk of major bleeding (RR = 0.29, 95%CI 0.08-1.01, I2 = 0%), variceal bleeding (RR = 1.29, 95%CI 0.64-2.59, I2 = 0%) and death (RR = 0.31, 95%CI 0.01-9.578, I2 = 80%) was similar between DOAC and VKA.CONCLUSION:
For the treatment of PVT in patients with cirrhosis, the bleeding risk was comparable between DOAC and VKA. However, DOAC were associated with a higher pooled rate of PVT recanalization. Dedicated randomized studies are needed to confirm these findings.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Vitamina K
/
Trombosis de la Vena
/
4-Hidroxicumarinas
/
Indenos
/
Cirrosis Hepática
/
Anticoagulantes
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Dig Liver Dis
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Singapur