Liver and Bile
Dig Liver Dis. 2022;54(1):56–62
Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: A systematic review and meta-analysis
Introduction and aim: Portal vein thrombosis (PVT) is associated with a higher risk of liver-related complications. Recent guidelines recommend direct-acting anticoagulants (DOAC) in patients with cirrhosis and non-tumoral PVT. However, data on the efficacy and safety of DOAC in these patients remain limited. The authors aim to investigate the efficacy and safety of DOAC compared to vitamin K antagonists (VKA) to treat non-tumoral PVT in patients with cirrhosis.
Methods: A systematic search of 6 electronic databases using MeSH term and free text was performed. They selected all studies comparing the use of DOAC with VKA to treat PVT in cirrhosis. The primary outcome was PVT recanalization. Secondary outcomes were PVT progression, major bleeding, variceal bleeding and death.
Results: From 944 citations, 552 subjects from a total of 11 studies (10 observational and 1 randomized trial) that fulfilled the inclusion criteria were included. The authors found that DOAC were associated with a higher pooled rate of PVT recanalization (relative risk ratio [RR] = 1.67, 95% confidence interval [CI]: 1.02–2.74, I2 = 79%) and lower pooled risk of PVT progression (RR = 0.14, 95% CI: 0.03–0.57, I2 = 0%). The pooled risk of major bleeding (RR = 0.29, 95% CI: 0.08–1.01, I2 = 0%), variceal bleeding (RR = 1.29, 95% CI: 0.64–2.59, I2 = 0%) and death (RR = 0.31, 95% CI: 0.01–9.578, I2 = 80%) was similar between DOAC and VKA.
Conclusion: For the treatment of portal vein thrombosis (PVT) in patients with cirrhosis, the bleeding risk was comparable between direct-acting anticoagulants (DOAC) and vitamin K antagonists. However, DOAC were associated with a higher pooled rate of PVT recanalization. Dedicated randomized studies are needed to confirm these findings.