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 com-plications. 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. We 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: We performed a systematic search of six electronic databases using MeSH term and free text. We selected all studies comparing the use of DOACs with vitamin K antagonist to treat PVT in cirrho-sis. The primary outcome was PVT recanalization. Secondary outcomes were and PVT progression, major bleeding, variceal bleeding and death. Results: From 944 citations, we included 552 subjects from a total of 11 studies (10 observational and 1 randomized trial) that fulfilled the inclusion criteria. We found that DOAC were associated with a higher pooled rate of PVT recanalization (RR = 1.67, 95%CI: 1.02, 2.74, I 2 = 79%) and lower pooled risk of PVT progression (RR = 0.14, 95%CI: 0.03-0.57, I 2 = 0%). The pooled risk of major bleeding (RR = 0.29, 95%CI: 0.08-1.01, I 2 = 0%), variceal bleeding (RR = 1.29, 95%CI: 0.64-2.59, I 2 = 0%) and death (RR = 0.31, 95%CI: 0.01-9.578, I 2 = 80%) was similar between DOAC and VKA. Conclusion: For the treatment of PVT in patients with cirrhosis, the bleeding risk was comparable be-tween DOAC and VKA. However, DOAC were associated with a higher pooled rate of PVT recanalization. Dedicated randomized studies are needed to confirm these findings. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study aimed to compare the efficacy and safety of DOAC versus VKA in treating non-tumoral PVT in cirrhotic patients. The results showed that DOAC were associated with higher PVT recanalization rate, but had similar bleeding risk compared to VKA.