Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis
ObjectivesEvidences for anticoagulation strategies in cirrhotic with portal vein thrombosis (PVT) are still insufficient. This study aims to comprehensively compare the therapeutic effects of different therapeutic therapeutic measures in individuals suffering from cirrhosis with PVT, with the ultima...
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Frontiers Media S.A.
2025-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1462338/full |
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| author | Hui-Jun Li Fu-Qiang Yin Yu-Tong Ma Teng-Yu Gao Yu-Ting Tao Xin Liu Xian-Feng Shen Chao Zhang |
| author_facet | Hui-Jun Li Fu-Qiang Yin Yu-Tong Ma Teng-Yu Gao Yu-Ting Tao Xin Liu Xian-Feng Shen Chao Zhang |
| author_sort | Hui-Jun Li |
| collection | DOAJ |
| description | ObjectivesEvidences for anticoagulation strategies in cirrhotic with portal vein thrombosis (PVT) are still insufficient. This study aims to comprehensively compare the therapeutic effects of different therapeutic therapeutic measures in individuals suffering from cirrhosis with PVT, with the ultimate goal of providing evidence-based recommendations for thrombolytic therapy in this population.MethodsStarting from 20 October 2023, a comprehensive search about therapeutic strategies for portal vein thrombosis in cirrhosis was conducted on PubMed, EMBASE, and Cochrane Library.Results19 studies were eventually incorporated into this study. Comparison with control in network meta-analysis, direct oral anticoagulants (DOACs) (RR = 2.15, 95%CI: 1.33, 3.48), LMWH (RR = 1.41, 95%CI: 1.01, 1.99), TIPS (RR = 5.68, 95%CI: 2.63, 12.24), warfarin (RR = 2.16, 95%CI: 1.46, 3.21), EBL plus propranolol (RR = 2.80, 95%CI: 1.18, 6.60), LMWH-DOACs sequential (RR = 7.92, 95%CI: 2.85, 21.99) and LMWH-warfarin sequential (RR = 2.26, 95%CI: 1.16, 4.42) significantly improved the incidence of complete recanalization. The anticoagulation drugs were ranked based on their SUCRA values, with the LMWH-DOACs sequential (92.7%), TIPS plus warfarin (91.3%), and TIPS (80.3%) emerging as the top three effective treatments.ConclusionIn this study, active anticoagulants were recommended for cirrhosis with PVT. The TIPS plus warfarin, LMWH-DOACs sequential, and TIPS improved the complete recanalization rate most effectively, and the EBL plus propranolol, heparin plus DOACs plus warfarin, and DOACs were highly recommended for increasing the incidence of partial recanalization. Warfarin and TIPS were recommended for reducing the frequency of bleeding events, while LMWH plus warfarin and DOACs proved to be most effective in decreasing the rate of major bleeding events. Warfarin, heparin plus DOACs plus warfarin, and DOACs demonstrated the most significant reduction in mortality rates, highlighting its potential as an effective intervention. TIPS plus warfarin, LMWH-DOACs sequential, and TIPS were recommended for reducing the occurrence of PVT expansion. Heparin plus DOACs plus warfarin was recommended for reducing the occurrence of hepatic encephalopathy, and protocols that involve TIPS were generally associated with a higher risk of hepatic encephalopathy. However, a longer follow-up period is necessary to comprehensively evaluate the efficacy of active anticoagulants therapy in patients with PVT in cirrhosis. |
| format | Article |
| id | doaj-art-7d7bc6186e904aa28e23f6219667b9f3 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-7d7bc6186e904aa28e23f6219667b9f32025-01-06T06:59:42ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.14623381462338Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysisHui-Jun Li0Fu-Qiang Yin1Yu-Tong Ma2Teng-Yu Gao3Yu-Ting Tao4Xin Liu5Xian-Feng Shen6Chao Zhang7Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaHepatobiliary and Pancreatic Research Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaCenter for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, ChinaObjectivesEvidences for anticoagulation strategies in cirrhotic with portal vein thrombosis (PVT) are still insufficient. This study aims to comprehensively compare the therapeutic effects of different therapeutic therapeutic measures in individuals suffering from cirrhosis with PVT, with the ultimate goal of providing evidence-based recommendations for thrombolytic therapy in this population.MethodsStarting from 20 October 2023, a comprehensive search about therapeutic strategies for portal vein thrombosis in cirrhosis was conducted on PubMed, EMBASE, and Cochrane Library.Results19 studies were eventually incorporated into this study. Comparison with control in network meta-analysis, direct oral anticoagulants (DOACs) (RR = 2.15, 95%CI: 1.33, 3.48), LMWH (RR = 1.41, 95%CI: 1.01, 1.99), TIPS (RR = 5.68, 95%CI: 2.63, 12.24), warfarin (RR = 2.16, 95%CI: 1.46, 3.21), EBL plus propranolol (RR = 2.80, 95%CI: 1.18, 6.60), LMWH-DOACs sequential (RR = 7.92, 95%CI: 2.85, 21.99) and LMWH-warfarin sequential (RR = 2.26, 95%CI: 1.16, 4.42) significantly improved the incidence of complete recanalization. The anticoagulation drugs were ranked based on their SUCRA values, with the LMWH-DOACs sequential (92.7%), TIPS plus warfarin (91.3%), and TIPS (80.3%) emerging as the top three effective treatments.ConclusionIn this study, active anticoagulants were recommended for cirrhosis with PVT. The TIPS plus warfarin, LMWH-DOACs sequential, and TIPS improved the complete recanalization rate most effectively, and the EBL plus propranolol, heparin plus DOACs plus warfarin, and DOACs were highly recommended for increasing the incidence of partial recanalization. Warfarin and TIPS were recommended for reducing the frequency of bleeding events, while LMWH plus warfarin and DOACs proved to be most effective in decreasing the rate of major bleeding events. Warfarin, heparin plus DOACs plus warfarin, and DOACs demonstrated the most significant reduction in mortality rates, highlighting its potential as an effective intervention. TIPS plus warfarin, LMWH-DOACs sequential, and TIPS were recommended for reducing the occurrence of PVT expansion. Heparin plus DOACs plus warfarin was recommended for reducing the occurrence of hepatic encephalopathy, and protocols that involve TIPS were generally associated with a higher risk of hepatic encephalopathy. However, a longer follow-up period is necessary to comprehensively evaluate the efficacy of active anticoagulants therapy in patients with PVT in cirrhosis.https://www.frontiersin.org/articles/10.3389/fphar.2024.1462338/fullportal vein thrombosiscirrhosisdirect oral anticoagulantstransjugular intrahepatic portosystemic shuntlow molecular weight heparinwarfarin |
| spellingShingle | Hui-Jun Li Fu-Qiang Yin Yu-Tong Ma Teng-Yu Gao Yu-Ting Tao Xin Liu Xian-Feng Shen Chao Zhang Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis Frontiers in Pharmacology portal vein thrombosis cirrhosis direct oral anticoagulants transjugular intrahepatic portosystemic shunt low molecular weight heparin warfarin |
| title | Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis |
| title_full | Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis |
| title_fullStr | Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis |
| title_full_unstemmed | Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis |
| title_short | Administration of anticoagulation strategies for portal vein thrombosis in cirrhosis: network meta-analysis |
| title_sort | administration of anticoagulation strategies for portal vein thrombosis in cirrhosis network meta analysis |
| topic | portal vein thrombosis cirrhosis direct oral anticoagulants transjugular intrahepatic portosystemic shunt low molecular weight heparin warfarin |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1462338/full |
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