抗凝有利于肝硬化合并门静脉血栓患者血栓再通和生存：荟萃分析结果。
Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis.
机构信息
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China.
Postgraduate College, Dalian Medical University, Dalian, China.
出版信息
Adv Ther. 2021 Jan;38(1):495-520. doi: 10.1007/s12325-020-01550-4. Epub 2020 Nov 5.
INTRODUCTION
Benefit and risk of anticoagulation in cirrhotic patients with portal vein thrombosis (PVT) remain controversial, especially in those with asymptomatic PVT and in non-liver transplant candidates. Furthermore, the predictors of portal vein recanalization and bleeding events after anticoagulation are critical for making clinical decisions, but still unclear. We conducted a meta-analysis to investigate the outcomes of anticoagulation for PVT in liver cirrhosis and explore the predictors of portal vein recanalization and bleeding events after anticoagulation.
METHODS
All studies regarding anticoagulation for PVT in liver cirrhosis were searched via PubMed, EMBASE, and Cochrane Library databases. Thrombotic outcomes, bleeding events, and survival were compared between anticoagulation and non-anticoagulation groups. Predictors of portal vein recanalization and bleeding events were pooled. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.
RESULTS
Thirty-three studies including 1696 cirrhotic patients with PVT were included. Anticoagulation significantly increased portal vein recanalization (RR = 2.61; 95% CI 1.99-3.43; P < 0.00001) and overall survival (RR = 1.11; 95% CI 1.03-1.21; P = 0.01) and decreased thrombus progression (RR = 0.26; 95% CI 0.14-0.49; P < 0.0001). Anticoagulation did not significantly influence overall bleeding (RR = 0.78; 95% CI 0.47-1.30; P = 0.34). Early initiation of anticoagulation (RR = 1.58; 95% CI 1.21-2.07; P = 0.0007) significantly increased portal vein recanalization. Child-Pugh class B and C (RR = 0.77; 95% CI 0.62-0.95; P = 0.02) and higher MELD score (MD = - 1.48; 95% CI - 2.20-0.76; P < 0.0001) were significantly associated with decreased portal vein recanalization. No predictor significantly associated with bleeding events was identified.
CONCLUSIONS
Early initiation of anticoagulation should be supported in liver cirrhosis with PVT. Predictors of portal vein recanalization should be taken into consideration to identify those who may not benefit from anticoagulation.
REGISTRATION
The work was registered in PROSPERO with registration no. CRD42020157142.
简介
在患有门静脉血栓形成（PVT）的肝硬化患者中，抗凝的获益和风险仍存在争议，尤其是在无症状 PVT 患者和非肝移植候选者中。此外，抗凝后门静脉再通和出血事件的预测因素对于做出临床决策至关重要，但仍不清楚。我们进行了一项荟萃分析，以研究抗凝治疗肝硬化 PVT 的结果，并探讨抗凝后门静脉再通和出血事件的预测因素。
方法
通过 PubMed、EMBASE 和 Cochrane 图书馆数据库检索所有关于肝硬化 PVT 抗凝治疗的研究。比较抗凝组和非抗凝组之间的血栓形成结局、出血事件和生存率。汇总门静脉再通和出血事件的预测因素。使用 95%置信区间（CI）计算风险比（RR）或均数差值（MD）。
结果
共纳入 33 项研究，包括 1696 例肝硬化合并 PVT 患者。抗凝治疗显著增加门静脉再通（RR=2.61；95%CI 1.99-3.43；P<0.00001）和总体生存率（RR=1.11；95%CI 1.03-1.21；P=0.01），并降低血栓进展（RR=0.26；95%CI 0.14-0.49；P<0.0001）。抗凝治疗对总体出血无显著影响（RR=0.78；95%CI 0.47-1.30；P=0.34）。早期开始抗凝治疗（RR=1.58；95%CI 1.21-2.07；P=0.0007）显著增加门静脉再通。Child-Pugh 分级 B 和 C（RR=0.77；95%CI 0.62-0.95；P=0.02）和较高的 MELD 评分（MD=-1.48；95%CI-2.20-0.76；P<0.0001）与门静脉再通减少显著相关。未发现与出血事件显著相关的预测因素。
结论
对于患有 PVT 的肝硬化患者，应支持早期开始抗凝治疗。应考虑门静脉再通的预测因素，以确定那些可能无法从抗凝治疗中获益的患者。
登记
本工作已在 PROSPERO 中注册，注册号为 CRD42020157142。
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