Risk-benefit profile of VKA in cirrhotic patients with portal vein thrombosis
Vitamin K antagonist (VKA) may increase the risk of minor bleeding in cirrhotic patients receiving anticoagulants for portal vein thrombosis (PVT), according to a study. However, this risk is compensated for by the ability of VKA to increase portal hypertension-related, event-free and transplantation-free survival of patients with PVT recanalization.
The retrospective study included 63 cirrhotic patients who received anticoagulants for a first detection of non-neoplastic PVT (PVT group) and 160 noncirrhotic patients with venous thromboembolism (VTE group) treated with VKA. Four-year data on bleeding events were compared between these two patient groups.
Additionally, data from 139 cirrhotic patients who did not receive VKAs (control group) were analysed for portal hypertension-related events. Survival analysis facilitated estimation of the effects of VKA in PVT patients as compared with controls.
The VTE and PVT groups were comparable with respect to age, sex and time in the therapeutic range, but patients with VTE received a longer duration of VKA treatment (31.1 vs 23.3 months; p=0.002). Major and minor bleeding occurred with greater frequency in the PVT group than in the VTE group (major: 24 vs 7 percent; p=0.012; minor: 29 vs 19 percent; p=0.024).
In particular, patients with PVT had a higher rate of major bleeding from the upper-GI tract compared with those with VTE (p=0.019), although there were no significant differences in other types of major bleeding (p=0.376). When compared with controls, the rate of upper-GI bleeding in PVT patients was similar.
In the PVT group, complete recanalization was independently associated with increased portal hypertension-related event-free and transplantation-free survival times.
Researchers noted that portal hypertension, rather than anticoagulants, could explain the difference in risk of major bleeding between patients with PVT and those with VTE.