Qi Xingshun, De Stefano Valerio, Li Hongyu, Dai Junna, Guo Xiaozhong, Fan Daiming
Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Institute of Hematology, Catholic University, Rome, Italy.
Eur J Intern Med. 2015 Jan;26(1):23-9. doi: 10.1016/j.ejim.2014.12.002. Epub 2015 Jan 5.
BACKGROUND & AIMS: Systematic review and meta-analysis were performed to evaluate the safety and efficacy of anticoagulation for the treatment of portal vein thrombosis (PVT) in cirrhotic patients.
The PubMed, EMBASE, Cochrane Library, and ScienceDirect databases were searched. The rates of bleeding complications and portal vein recanalization in patients who received anticoagulant therapy were pooled. The odds ratio (OR) with 95% confidence interval (CI) was calculated to express the difference in the rate of portal vein recanalization between anticoagulation and non-anticoagulation groups. All meta-analyses were conducted by using a random-effects model.
Sixteen of 960 initially identified papers were included. Two studies reported a low incidence of major anticoagulation-related complications (4% [2/55] and 3% [1/33]), but no lethal complications occurred. The rate of anticoagulation-related bleeding ranged from 0% to 18% with a pooled rate of 3.3% (95% CI=1.1%-6.7%). The heterogeneity was not significant in the meta-analysis. The total rate of portal vein recanalization ranged from 37% to 93% with a pooled rate of 66.6% (95% CI=54.7%-77.6%). The rate of complete portal vein recanalization ranged from 0% to 75% with a pooled rate of 41.5% (95% CI=29.2%-54.5%). However, the heterogeneity was significant in the 2 meta-analyses. The rate of complete portal vein recanalization was significantly higher in anticoagulation group than in non-anticoagulation group (OR=4.16, 95% CI=1.88-9.20, P=0.0004). The heterogeneity was not significant in the meta-analysis.
Anticoagulation could achieve a relatively high rate of portal vein recanalization in cirrhotic patients with PVT. Given that only a small number of non-randomized comparative studies are reported, randomized controlled trials are warranted to confirm the risk-to-benefit of anticoagulation in such patients, especially anticoagulation-related bleeding.
进行系统评价和荟萃分析，以评估抗凝治疗肝硬化患者门静脉血栓形成（PVT）的安全性和有效性。
检索了PubMed、EMBASE、Cochrane图书馆和ScienceDirect数据库。汇总接受抗凝治疗患者的出血并发症发生率和门静脉再通率。计算95%置信区间（CI）的比值比（OR），以表达抗凝组和非抗凝组门静脉再通率的差异。所有荟萃分析均采用随机效应模型进行。
最初识别的960篇论文中有16篇被纳入。两项研究报告主要抗凝相关并发症的发生率较低（4%[2/55]和3%[1/33]），但未发生致命并发症。抗凝相关出血率为0%至18%，汇总率为3.3%（95%CI=1.1%-6.7%）。荟萃分析中的异质性不显著。门静脉再通总率为37%至93%，汇总率为66.6%（95%CI=54.7%-77.6%）。门静脉完全再通率为0%至75%，汇总率为41.5%（95%CI=29.2%-54.5%）。然而，在两项荟萃分析中异质性显著。抗凝组门静脉完全再通率显著高于非抗凝组（OR=4.16，95%CI=1.88-9.20，P=0.0004）。荟萃分析中的异质性不显著。
抗凝治疗可使肝硬化合并PVT患者达到相对较高的门静脉再通率。鉴于仅报道了少量非随机对照研究，有必要进行随机对照试验以确认此类患者抗凝治疗的风险效益，尤其是抗凝相关出血。
