Valeriani Emanuele, Di Nisio Marcello, Riva Nicoletta, Cohen Omri, Porreca Ettore, Senzolo Marco, De Gottardi Andrea, Magaz Marta, Garcia-Pagan Juan-Carlos, Ageno Walter
Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.
Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy.
Thromb Haemost. 2021 Jul;121(7):867-876. doi: 10.1055/s-0040-1722192. Epub 2021 Feb 1.
Splanchnic vein thrombosis (SVT) is a common complication in patients with liver cirrhosis. The aim of this study was to evaluate the efficacy and safety of anticoagulant therapy for SVT in cirrhotic patients.
In this systematic review and meta-analysis, studies reporting on SVT recanalization and progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were searched in MEDLINE, EMBASE, and ClinicalTrial.gov up to December 2019. Pooled proportions and risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated.
A total of 1,475 patients were included in 26 studies (23 observational and 3 randomized controlled trials). In patients receiving anticoagulant therapy, SVT recanalization occurred in 68% (95% CI, 62-74; 571/842 patients; 22 studies), SVT progression in 6% (95% CI, 4-9; 25/748 patients; 22 studies), recurrent VTE in 10% (95% CI, 4-22; 48/399 patients; 7 studies), major bleeding in 6% (95% CI, 4-10; 58/785 patients; 18 studies), and overall mortality in 9% (95% CI, 6-14; 68/787 patients; 17 studies). Anticoagulant treatment was associated with higher SVT recanalization (RR 3.19; 95% CI, 1.42-7.17), lower thrombosis progression (RR 0.28; 95% CI, 0.15-0.52), major bleeding (RR 0.52; 95% CI, 0.28-0.97), and overall mortality (RR 0.42; 95% CI, 0.24-0.73) compared with no treatment.
Anticoagulant therapy seems to improve vein recanalization and to reduce SVT progression, major bleeding, and overall mortality in cirrhotic patients with SVT. The incidence of recurrent VTE during anticoagulation remains substantial.
内脏静脉血栓形成（SVT）是肝硬化患者的常见并发症。本研究旨在评估抗凝治疗对肝硬化患者SVT的疗效和安全性。
在本系统评价和荟萃分析中，检索了截至2019年12月MEDLINE、EMBASE和ClinicalTrial.gov上报告SVT再通和进展、复发性静脉血栓栓塞（VTE）、大出血和全因死亡率的研究。计算合并比例和风险比（RR）以及相应的95%置信区间（CI）。
26项研究（23项观察性研究和3项随机对照试验）共纳入1475例患者。接受抗凝治疗的患者中，SVT再通率为68%（95%CI，62 - 74；571/842例患者；22项研究），SVT进展率为6%（95%CI，4 - 9；25/748例患者；22项研究），复发性VTE发生率为10%（95%CI，4 - 22；48/399例患者；7项研究），大出血发生率为6%（95%CI，4 - 10；58/785例患者；18项研究），全因死亡率为9%（95%CI，6 - 14；68/787例患者；17项研究）。与未治疗相比，抗凝治疗与更高的SVT再通率（RR 3.19；95%CI，1.42 - 7.17）、更低的血栓进展率（RR 0.28；95%CI，0.15 - 0.52）、大出血率（RR 0.52；95%CI，0.28 - 0.97）和全因死亡率（RR 0.42；95%CI，0.24 - 0.73）相关。
抗凝治疗似乎可改善静脉再通，并降低肝硬化合并SVT患者的SVT进展、大出血和全因死亡率。抗凝期间复发性VTE的发生率仍然较高。
