Volk Michael L, Ogola Gerald O, Northup Patrick G
Department of Medicine, Baylor Scott and White Health, Temple, Texas, USA.
Baylor Scott and White Research Institute, Dallas, Texas, USA.
Proc (Bayl Univ Med Cent). 2024 Dec 27;38(2):121-125. doi: 10.1080/08998280.2024.2444145. eCollection 2025.
Portal vein thrombosis (PVT) is common among patients with cirrhosis, but the independent impact on outcomes and management is uncertain. We aimed to determine whether the development of PVT is independently associated with mortality, bleeding, and hospitalization and whether anticoagulation improves these outcomes.
Patients with cirrhosis and PVT were identified using billing codes from a large health system between 2016 and 2023 and compared to matched control cirrhosis patients without PVT. Among the cohort with PVT, those who received anticoagulation were compared to those who did not. Outcomes included mortality, gastrointestinal bleeding, and hospitalization. Adjustment for confounding was performed using propensity score analysis.
Among 48,596 patients with cirrhosis, 1332 formed the PVT cohort and 3440 formed the non-PVT matched cohort. On adjusted analysis, patients with PVT had higher mortality (hazard ratio [HR] 1.33, < 0.001), bleeding (HR 1.41, < 0.001), and hospitalization (incidence rate ratio [IRR] 1.25, < 0.001). Among the 1161 PVT patients meeting inclusion criteria, 768 received no anticoagulation, 309 received anticoagulation for ≤90 days, and 84 received anticoagulation for >90 days. In the unadjusted analysis, anticoagulation was associated with lower mortality (log-rank = 0.004), with a dose-response relationship. After propensity score adjustment, the association between anticoagulation and lower mortality persisted but no longer reached statistical significance (HR 0.8, = 0.075). However, anticoagulation remained associated with higher bleeding (HR 1.67, = 0.004) and hospitalization (IRR 1.43, < 0.001).
Among patients with cirrhosis, PVT is independently associated with a higher risk of mortality, bleeding, and hospitalization. Anticoagulation may improve overall survival but is associated with a higher risk of bleeding and hospitalization.
门静脉血栓形成（PVT）在肝硬化患者中很常见，但对预后和治疗的独立影响尚不确定。我们旨在确定PVT的发生是否与死亡率、出血和住院独立相关，以及抗凝治疗是否能改善这些预后。
利用2016年至2023年期间一个大型医疗系统的计费代码识别出肝硬化合并PVT的患者，并与匹配的无PVT的对照肝硬化患者进行比较。在PVT队列中，将接受抗凝治疗的患者与未接受抗凝治疗的患者进行比较。结局包括死亡率、胃肠道出血和住院情况。使用倾向评分分析对混杂因素进行调整。
在48596例肝硬化患者中，1332例组成PVT队列，3440例组成非PVT匹配队列。经调整分析，PVT患者的死亡率更高（风险比[HR] 1.33，<0.001）、出血风险更高（HR 1.41，<0.001）和住院率更高（发病率比[IRR] 1.25，<0.001）。在1161例符合纳入标准的PVT患者中，768例未接受抗凝治疗，309例接受抗凝治疗≤90天，84例接受抗凝治疗>90天。在未调整分析中，抗凝治疗与较低死亡率相关（对数秩检验=0.004），存在剂量反应关系。经过倾向评分调整后，抗凝治疗与较低死亡率之间的关联仍然存在，但不再具有统计学意义（HR 0.8，=0.075）。然而，抗凝治疗仍然与较高的出血风险（HR 1.67，=0.004）和住院率（IRR 1.43, <0.001）相关。
在肝硬化患者中，PVT与更高的死亡、出血和住院风险独立相关。抗凝治疗可能改善总体生存率，但与更高的出血和住院风险相关。
