Abstract
Background & Aims: Vitamin K antagonists (VKAs) promote recanalization of portal vein thrombosis (PVT) in patients with cirrhosis. However, the benefit of PVT recanalization might be offset by major and minor bleeding associated with use of anticoagulants. We evaluated harmful and beneficial effects of VKA in patients with PVT and cirrhosis. Methods: We performed a retrospective study of 63 consecutive patients with cirrhosis given anticoagulants for the first detection of non-neoplastic PVT from 2003 to 2015 in Italy. We collected data on bleeding events in these patients and compared them with those from patients without cirrhosis with venous thromboembolism (VTE) (n = 160) for up to 4 years. Time in the therapeutic range, based on the international normalized ratio, was used to determine the quality of anticoagulation. We also collected data from 139 patients with cirrhosis who did not receive VKAs (controls), to analyze portal hypertension-related events. We performed survival analyses to determine the effects of VKA in patients with PVT vs controls. Results: The group with VTE and the group with PVT were comparable in age, sex, and time in the therapeutic range, but patients with VTE received VKAs for a longer time period (31.1 ± 16.9 mo vs 23.3 ± 16.2 mo; P =.002). The incidence of major or minor bleeding was higher in patients with PVT than patients with VTE (major, 24% vs 7%; P =.012; minor, 29% vs 19%; P =.024). Patients with PVT had a higher rate of major bleeding from the upper-gastrointestinal tract than patients with VTE (P =.019), but there were no significant differences in other types of major bleeding (P =.376). Patients with PVT and controls had the same rate of upper-gastrointestinal bleeding. Complete recanalization in patients with PVT receiving VKA (n = 31) was independently associated with increased portal hypertension–related event-free and transplantation-free survival times. Conclusions: In a retrospective analysis of 63 patients with cirrhosis given anticoagulants for PVT, we found VKA use to increase risk of minor bleeding, compared with patients without cirrhosis given VKA. However, this risk is offset by the ability of VKA to increase portal hypertension–related, event-free, and transplantation-free survival of patients with PVT recanalization. Portal hypertension, rather than anticoagulants, could account for the difference in risk of major bleeding between patients with PVT vs patients with VTE.
| Original language | English |
|---|---|
| Pages (from-to) | 1146-1152.e4 |
| Journal | Clinical Gastroenterology and Hepatology |
| Volume | 16 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2018 |
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Keywords
- Hemorrhage
- Portal Hypertension
- Survival
- Vitamin K Antagonist
ASJC Scopus subject areas
- Hepatology
- Gastroenterology
Cite this
Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis. / La Mura, Vincenzo; Braham, Simon; Tosetti, Giulia; Branchi, Federica; Bitto, Niccolò; Moia, Marco; Fracanzani, Anna Ludovica; Colombo, Massimo; Tripodi, Armando; Primignani, Massimo.
In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 7, 2018, p. 1146-1152.e4.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis
AU - La Mura, Vincenzo
AU - Braham, Simon
AU - Tosetti, Giulia
AU - Branchi, Federica
AU - Bitto, Niccolò
AU - Moia, Marco
AU - Fracanzani, Anna Ludovica
AU - Colombo, Massimo
AU - Tripodi, Armando
AU - Primignani, Massimo
PY - 2018
Y1 - 2018
N2 - Background & Aims: Vitamin K antagonists (VKAs) promote recanalization of portal vein thrombosis (PVT) in patients with cirrhosis. However, the benefit of PVT recanalization might be offset by major and minor bleeding associated with use of anticoagulants. We evaluated harmful and beneficial effects of VKA in patients with PVT and cirrhosis. Methods: We performed a retrospective study of 63 consecutive patients with cirrhosis given anticoagulants for the first detection of non-neoplastic PVT from 2003 to 2015 in Italy. We collected data on bleeding events in these patients and compared them with those from patients without cirrhosis with venous thromboembolism (VTE) (n = 160) for up to 4 years. Time in the therapeutic range, based on the international normalized ratio, was used to determine the quality of anticoagulation. We also collected data from 139 patients with cirrhosis who did not receive VKAs (controls), to analyze portal hypertension-related events. We performed survival analyses to determine the effects of VKA in patients with PVT vs controls. Results: The group with VTE and the group with PVT were comparable in age, sex, and time in the therapeutic range, but patients with VTE received VKAs for a longer time period (31.1 ± 16.9 mo vs 23.3 ± 16.2 mo; P =.002). The incidence of major or minor bleeding was higher in patients with PVT than patients with VTE (major, 24% vs 7%; P =.012; minor, 29% vs 19%; P =.024). Patients with PVT had a higher rate of major bleeding from the upper-gastrointestinal tract than patients with VTE (P =.019), but there were no significant differences in other types of major bleeding (P =.376). Patients with PVT and controls had the same rate of upper-gastrointestinal bleeding. Complete recanalization in patients with PVT receiving VKA (n = 31) was independently associated with increased portal hypertension–related event-free and transplantation-free survival times. Conclusions: In a retrospective analysis of 63 patients with cirrhosis given anticoagulants for PVT, we found VKA use to increase risk of minor bleeding, compared with patients without cirrhosis given VKA. However, this risk is offset by the ability of VKA to increase portal hypertension–related, event-free, and transplantation-free survival of patients with PVT recanalization. Portal hypertension, rather than anticoagulants, could account for the difference in risk of major bleeding between patients with PVT vs patients with VTE.
AB - Background & Aims: Vitamin K antagonists (VKAs) promote recanalization of portal vein thrombosis (PVT) in patients with cirrhosis. However, the benefit of PVT recanalization might be offset by major and minor bleeding associated with use of anticoagulants. We evaluated harmful and beneficial effects of VKA in patients with PVT and cirrhosis. Methods: We performed a retrospective study of 63 consecutive patients with cirrhosis given anticoagulants for the first detection of non-neoplastic PVT from 2003 to 2015 in Italy. We collected data on bleeding events in these patients and compared them with those from patients without cirrhosis with venous thromboembolism (VTE) (n = 160) for up to 4 years. Time in the therapeutic range, based on the international normalized ratio, was used to determine the quality of anticoagulation. We also collected data from 139 patients with cirrhosis who did not receive VKAs (controls), to analyze portal hypertension-related events. We performed survival analyses to determine the effects of VKA in patients with PVT vs controls. Results: The group with VTE and the group with PVT were comparable in age, sex, and time in the therapeutic range, but patients with VTE received VKAs for a longer time period (31.1 ± 16.9 mo vs 23.3 ± 16.2 mo; P =.002). The incidence of major or minor bleeding was higher in patients with PVT than patients with VTE (major, 24% vs 7%; P =.012; minor, 29% vs 19%; P =.024). Patients with PVT had a higher rate of major bleeding from the upper-gastrointestinal tract than patients with VTE (P =.019), but there were no significant differences in other types of major bleeding (P =.376). Patients with PVT and controls had the same rate of upper-gastrointestinal bleeding. Complete recanalization in patients with PVT receiving VKA (n = 31) was independently associated with increased portal hypertension–related event-free and transplantation-free survival times. Conclusions: In a retrospective analysis of 63 patients with cirrhosis given anticoagulants for PVT, we found VKA use to increase risk of minor bleeding, compared with patients without cirrhosis given VKA. However, this risk is offset by the ability of VKA to increase portal hypertension–related, event-free, and transplantation-free survival of patients with PVT recanalization. Portal hypertension, rather than anticoagulants, could account for the difference in risk of major bleeding between patients with PVT vs patients with VTE.
KW - Hemorrhage
KW - Portal Hypertension
KW - Survival
KW - Vitamin K Antagonist
UR - http://www.scopus.com/inward/record.url?scp=85046167224&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046167224&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2017.10.016
DO - 10.1016/j.cgh.2017.10.016
M3 - Article
AN - SCOPUS:85046167224
VL - 16
SP - 1146-1152.e4
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 7
ER -