抗凝剂在肝硬化合并门静脉血栓形成患者中的疗效和安全性：一项对随机和非随机研究的系统评价与荟萃分析
Efficacy and Safety of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-Analysis of Randomized and Non-Randomized Studies.
作者信息
Waseem Muhammad Hassan, Abideen Zain Ul, Khan Marium, Sajid Barka, Ramzan Noor Ul Huda, Farid Rabeya, Iqbal Javed, Ahmed Jalib, Kabir Aqsa, Shahzad Maryam, Asif Javeria, Osama Muhammad, Aimen Sania, Chaudhary Ammad Javaid, Cheema Ameer Haider
机构信息
Allama Iqbal Medical College Lahore Pakistan.
King Edward Medical University Neela Gumbad Lahore Pakistan.
出版信息
JGH Open. 2025 Aug 8;9(8):e70194. doi: 10.1002/jgh3.70194. eCollection 2025 Aug.
BACKGROUND
Portal vein thrombosis (PVT) contributes substantially to morbidity and mortality in cirrhotic patients. A clear insight into the anticoagulation therapy benefits in these patients could improve clinical decision-making. This meta-analysis aimed to assess the efficacy and safety of Anticoagulants in cirrhotic patients with PVT.
METHODS
PubMed, Cochrane Library, and ScienceDirect were searched from inception to September 2024. The Risk Ratios (RR) with 95% Confidence Interval (CI) were pooled for dichotomous outcomes under the random effects model using Review Manager 5.4.1. The primary endpoint of interest is PVT recanalization. Quality assessment was done through the Newcastle Ottawa Scale and the Cochrane RoB2.0 tool. Leave-one-out sensitivity analysis was done to investigate the cause of heterogeneity. Publication bias was assessed through funnel plots.
RESULTS
Twenty-three studies (including 19 cohorts and 4 Randomized trials), pooling 81,599 patients, were included in the analysis. Anticoagulants significantly increased the PVT recanalization (RR = 2.00; 95% CI: [1.59, 2.52]; < 0.00001; = 13%), PVT improvement (RR = 1.98; 95% CI: [1.70, 2.29], < 0.00001; = 0%) while decreasing the PVT stability (RR = 0.78; 95% CI: [0.62,0.99], = 0.04; = 19%) and PVT progression (RR = 0.42; 95% CI: [0.29, 0.60], < 0.00001; = 27%). Other outcomes including mortality (RR = 0.53; 95% CI: [0.27, 1.03]; = 0.06; = 94%), total bleeding (RR = 1.02; 95% CI: [0.76, 1.37], = 0.89; = 31%), esophageal variceal bleeding (RR = 0.74; 95% CI: [0.54, 1.01], = 0.06; = 56%), Gastrointestinal bleeding (RR = 1.07; 95% CI: [0.78, 1.48]; = 0.66, = 13%) and Intracranial hemorrhage (RR = 1.19; 95% CI: [0.89, 1.58], = 0.24, = 0%) were comparable between the 2 arms.
CONCLUSION
Anticoagulants significantly increased PVT recanalization and PVT improvement while decreasing PVT stability and PVT progression in cirrhotic patients. Other outcomes were comparable between the two groups.
背景
门静脉血栓形成（PVT）在肝硬化患者的发病和死亡中起重要作用。深入了解抗凝治疗对这些患者的益处有助于改善临床决策。本荟萃分析旨在评估抗凝剂在肝硬化合并PVT患者中的疗效和安全性。
方法
检索PubMed、Cochrane图书馆和ScienceDirect数据库，检索时间从建库至2024年9月。使用Review Manager 5.4.1软件，在随机效应模型下，对二分结局合并95%置信区间（CI）的风险比（RR）进行汇总分析。主要观察终点为PVT再通。通过纽卡斯尔渥太华量表和Cochrane RoB2.0工具进行质量评估。采用留一法敏感性分析来探究异质性的原因。通过漏斗图评估发表偏倚。
结果
纳入分析的有23项研究（包括19项队列研究和4项随机试验），共81,599例患者。抗凝剂显著提高了PVT再通率（RR = 2.00；95%CI：[1.59, 2.52]；P < 0.00001；I² = 13%）、PVT改善率（RR = 1.98；95%CI：[1.70, 2.29]，P < 0.00001；I² = 0%），同时降低了PVT稳定性（RR = 0.78；95%CI：[0.62, 0.99]，P = 0.04；I² = 19%）和PVT进展率（RR = 0.42；95%CI：[0.29, 0.60]，P < 0.00001；I² = 27%）。其他结局包括死亡率（RR = 0.53；95%CI：[0.27, 1.03]；P = 0.06；I² = 94%）、总出血率（RR = 1.02；95%CI：[0.76, 1.37]，P = 0.89；I² = 31%）、食管静脉曲张出血率（RR = 0.74；95%CI：[0.54, 1.01]，P = 0.06；I² = 56%）、胃肠道出血率（RR = 1.07；95%CI：[0.78, 1.48]；P = 0.66，I² = 13%）和颅内出血率（RR = 1.19；95%CI：[0.89, 1.58]，P = 0.24，I² = 0%），两组之间相当。
结论
抗凝剂显著提高了肝硬化患者的PVT再通率和PVT改善率，同时降低了PVT稳定性和PVT进展率。两组的其他结局相当。
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