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Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis

  • Carlos Noronha FerreiraEmail author
  • Daniela Reis
  • Helena Cortez-Pinto
  • Rui Tato Marinho
  • Afonso Gonçalves
  • Sónia Palma
  • Inês Leite
  • Tiago Rodrigues
  • Ana Júlia Pedro
  • Paula Alexandrino
  • Fátima Serejo
  • Margarida Sobral Dias
  • Paula Ferreira
  • Mariana Vasconcelos
  • Filipe Damião
  • Leonor Xavier Brito
  • Cilenia Baldaia
  • Narcisa Fatela
  • Fernando Ramalho
  • José Velosa
Original Article
  • 89 Downloads

Abstract

Background

The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial.

Aims

We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival.

Methods

Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis.

Results

Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p = 0.005]. OLT-free survival after a median follow-up of 25 (1–146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not (p = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01–1.21, p = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05–1.19, p < 0.001).

Conclusions

Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.

Keywords

Portal vein thrombosis Cirrhosis Anticoagulation Rethrombosis Orthotopic liver transplantation Prognosis 

Abbreviations

PVT

Portal vein thrombosis

US

Ultrasound

OLT

Orthotopic liver transplantation

LMWH

Low molecular weight heparin

AT

Anticoagulant therapy

HCC

Hepatocellular carcinoma

CT

Computerized tomography

MRI

Magnetic resonance imaging

TIPS

Transjugular intrahepatic portosystemic shunt

KM

Kaplan–Meier

MELD

Model for End-Stage Liver Disease

GOV1

Gastroesophageal varices type 1

IGV

Isolated gastric varices

GOV2

Gastroesophageal varices type 2

UGIB

Upper gastrointestinal bleeding

Notes

Acknowledgments

We would like to express our sincere thanks to Professors Dominique Valla and Juan Carlos García-Pagán for their constructive comments and expert advice in preparation of this manuscript, Dr. Teresa Rodrigues for her valuable support and advice regarding statistical analysis of this manuscript, and Drs. Filipe Calinas, Joana Saiote, and Mario Silva for their help in data collection in some patients.

Author’s contribution

Carlos Noronha Ferreira, MD, was involved in study design, patient inclusion, data collection, data analysis and preparation, and critical review of the manuscript. Daniela Reis, MD, performed data collection and critical review of the manuscript. Helena Cortez-Pinto, PhD, Rui Tato Marinho, PhD, Afonso Gonçalves, MD, Sónia Palma, MD, Inês Leite, MD, Tiago Rodrigues, MD, Ana Júlia Pedro, MD, Paula Alexandrino, MD, Fátima Serejo, PhD, Margarida Sobral Dias, MD, Paula Ferreira, MD, Mariana Vasconcelos, MD, Filipe Damião, MD, Leonor Xavier Brito, MD, Cilenia Baldaia, MD, Narcisa Fatela, MD, Fernando Ramalho, PhD, José Velosa, PhD, were all involved in patient inclusion and critical review of the manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to declare related to the study.

Ethics standards

Individual formal consent was not required, and institutional ethics committee approval was obtained, and the study was conducted according to the 1964 Declaration of Helsinki, later amendments, or comparable ethics standards.

Supplementary material

10620_2019_5572_MOESM1_ESM.docx (242 kb)
Supplementary material 1 (DOCX 241 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Carlos Noronha Ferreira
    • 1
    Email author
  • Daniela Reis
    • 1
  • Helena Cortez-Pinto
    • 1
  • Rui Tato Marinho
    • 1
  • Afonso Gonçalves
    • 2
  • Sónia Palma
    • 2
  • Inês Leite
    • 2
  • Tiago Rodrigues
    • 2
  • Ana Júlia Pedro
    • 3
  • Paula Alexandrino
    • 1
  • Fátima Serejo
    • 1
  • Margarida Sobral Dias
    • 1
  • Paula Ferreira
    • 1
  • Mariana Vasconcelos
    • 1
  • Filipe Damião
    • 1
  • Leonor Xavier Brito
    • 1
  • Cilenia Baldaia
    • 1
  • Narcisa Fatela
    • 1
  • Fernando Ramalho
    • 1
  • José Velosa
    • 1
  1. 1.Serviço De Gastrenterologia e HepatologiaHospital de Santa Maria – Centro Hospitalar Universitário Lisboa NorteLisbonPortugal
  2. 2.Serviço De ImagiologiaHospital de Santa Maria – Centro Hospitalar Universitário Lisboa NorteLisbonPortugal
  3. 3.Serviço De Medicina IIHospital De Santa Maria - Centro Hospitalar LisboaLisbonPortugal

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