Anticoagulation outcomes in cirrhotic patients with portal vein thrombosis: a tertiary center study.

Study purpose: This study assesses the efficacy and safety of direct oral anticoagulants (DOACs) compared to traditional anticoagulants in managing portal vein thrombosis (PVT), aiming to address critical gaps in both research and clinical practice.

Study design: We conducted a retrospective analysis at Rochester General Hospital from January 2011 to December 2023, involving 275 cirrhotic patients with PVT. The inclusion criteria included confirmed non-neoplastic PVT by imaging.

Results: Analysis of 275 cirrhotic patients with PVT revealed no significant differences in age and gender between those treated with anticoagulants and those untreated. The mortality rate was significantly lower in the treated group (37.7%) compared to the untreated group (51.7%; P = 0.029). Gastrointestinal bleeding was slightly more prevalent in the treated group (60.7%) than in the untreated group (58.1%; P = 0.690), though not statistically significant. A significant reduction in intracranial hemorrhage was observed in the treated group (2.5% vs. 8.5% in the untreated group; P = 0.038). In a subgroup analysis comparing the outcomes and side effects of DOACs, Warfarin, and low molecular weight heparins (LMWH) in treated PVT patients, the DOAC group showed improved survival rates compared to traditional [vitamin K antagonists (VKA)/LMWH] treatment, a log-rank test indicated significant survival improvement (chi2 (1) = 8.27, P = 0.0040). DOACs demonstrated comparable mortality rates to VKAs (34.2% vs. 34.5%, P = 0.979) and a significant survival benefit over LMWH (33.3% vs. 60.0%, P = 0.030).

Conclusion: DOAC in treating PVT among patients with liver cirrhosis, demonstrating better significant survival rate when compared to traditional anticoagulation. Key message What is already known on this topic  Portal vein thrombosis (PVT) is significantly more prevalent in patients with liver cirrhosis compared to the general population, posing substantial management challenges. Previous studies have primarily focused on small cohorts and retrospective data, underscoring the need for robust, large-scale analyses to validate the efficacy and safety of direct oral anticoagulants (DOACs) versus traditional therapies. What this study adds  This study provides concrete evidence from a large cohort that DOACs not only offer a survival benefit over traditional anticoagulation therapies like Warfarin and LMWH in cirrhotic patients with PVT but also maintain comparable safety profiles. These findings bridge significant gaps in current research by comparing the outcomes of modern versus traditional anticoagulant approaches in a real-world setting. How this study might affect research, practice, or policy  The results advocate for the inclusion of DOACs in clinical guidelines for managing PVT in cirrhosis, potentially shifting clinical practice toward these agents. Furthermore, the detailed comparison and subgroup analyses provide a strong foundation for future randomized controlled trials, which could further refine anticoagulation strategies in this high-risk population.