E0503 - Safety and Efficacy of Anticoagulation in Management of Non-Tumoral Portal Vein Thrombosis in Patients With Cirrhosis: A Review of Literature and Meta-Analysis

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Bola Nashed, MD

Ascension St. John Hospital
Detroit, MI

Bola Nashed, MD¹, Talal Bazzi, MD¹, Hussein Gharib, MD¹, Mohamed Issa, MD¹, Sara Bebawy, MD², Mohammed Barawi, MD¹
¹Ascension St. John Hospital, Detroit, MI; ²Ain Shams University, Cairo, Al Qahirah, Egypt

Introduction: Although current guidelines suggest the use of anticoagulation in managing portal vein thrombosis in patients with cirrhosis, however many physicians find this decision a challenging one. Given the limited data regarding the safety of anticoagulation in this high-risk patient population, we aim to investigate the safety and efficacy of anticoagulation in non-tumoral portal vein thrombosis in patients with cirrhosis.

Methods: We conducted a meta-analysis that included 5 prospective and 7 retrospective observational studies which involved 997 patients. We compared the rates of portal vein recanalization, bleeding events, and mortality between patients who received anticoagulation versus those who did not.

Results: The rate of complete portal vein recanalization was significantly higher in patients who received anticoagulation compared to those who did not: 32% vs 16.7%; relative risk (RR) 1.92, 95% confidence interval (CI) 1.35-2.74; P< 0.001. Progression of the portal vein thrombosis was significantly lower in the treatment group with RR 0.49; 95% CI 0.34-0.7; P< 0.001. Variceal bleeding rate was significantly lower in the treatment group with RR 0.63; 95% CI 0.41-0.98; P < 0.05. Mortality was significantly lower in the treatment group versus the no-treatment group: 7.2% vs 15.5%; RR 0.49, 95% CI 0.35-0.69; P< 0.001.

Discussion: Anticoagulation is safe and effective in the treatment of non-tumoral portal vein thrombosis in patients with cirrhosis. Patients in the anticoagulation group had significantly lower rates of variceal bleeding and mortality, and higher rates of recanalization of the portal vein.

Figure: Relative risk of mortality is significantly lower in the treatment group

Disclosures:

Bola Nashed indicated no relevant financial relationships.

Talal Bazzi indicated no relevant financial relationships.

Hussein Gharib indicated no relevant financial relationships.

Mohamed Issa indicated no relevant financial relationships.

Sara Bebawy indicated no relevant financial relationships.

Mohammed Barawi: Abbvie – Speakers Bureau. Gilead – Speakers Bureau. Medtronic – Consultant.

Bola Nashed, MD¹, Talal Bazzi, MD¹, Hussein Gharib, MD¹, Mohamed Issa, MD¹, Sara Bebawy, MD², Mohammed Barawi, MD¹. E0503 - Safety and Efficacy of Anticoagulation in Management of Non-Tumoral Portal Vein Thrombosis in Patients With Cirrhosis: A Review of Literature and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.