肝硬化患者门静脉血栓抗凝治疗的系统评价和荟萃分析：治

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肝硬化患者门静脉血栓抗凝治疗的系统评价和荟萃分析：治疗还是不治疗？

    Shujie Dong, Huihong Qi, Yan Li, Peng Men, Maiwujudan Alifu, Yatong Zhang, Yongjun Li & Rongsheng Zhao

Hepatology International 第 15 卷，第 1356–1375 页（2021）引用本文

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目的

迄今为止，指南或共识尚未确定肝硬化患者门静脉血栓形成 (PVT) 的最佳治疗方法。我们进行了系统评价和荟萃分析，以评估抗凝治疗对肝硬化和 PVT 患者的影响。
方法

检索了 PubMed、Embase、Cochrane 对照试验中心注册中心和 ClinicalTrials.gov（截至 2020 年 10 月 31 日），以评估抗凝治疗对治疗肝硬化患者 PVT 的影响。优势比 (OR) 及其 95% 置信区间 (CI) 使用 Mantel-Haenszel 方法合并。
结果

共有 13 项研究被纳入分析，包括 6005 名患者。其中，三项是前瞻性队列研究，九项是回顾性队列研究，一项是病例对照研究。与不治疗相比，抗凝治疗与更高的 PVT 再通率相关（OR 4.29；95% CI 3.01–6.13）。与未治疗相比，抗凝治疗显示 PVT 延长显着减少 74%（OR 0.26；95% CI 0.14–0.49）。抗凝治疗与非显着性较低的死亡风险相关（OR 0.53；95% CI 0.20–1.40）。然而，与不治疗相比，抗凝治疗的出血风险略高（OR 1.16；95% CI 1.02–1.32）。
结论

在肝硬化 PVT 患者中，抗凝治疗有助于提高 PVT 再通率和提高生存率，但与不治疗相比，出血风险也可能更高。我们的研究结果支持在肝硬化 PVT 患者中使用抗凝治疗。

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A systematic review and meta-analysis of anticoagulation therapy for portal vein thrombosis in patients with cirrhosis: to treat or not to treat?

    Shujie Dong, Huihong Qi, Yan Li, Peng Men, Maiwujudan Alifu, Yatong Zhang, Yongjun Li & Rongsheng Zhao

Hepatology International volume 15, pages 1356–1375 (2021)Cite this article

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Abstract
Purpose

To date, the optimal treatment for portal vein thrombosis (PVT) in cirrhotic patients has not been established in guidelines or consensus. We conducted a systematic review and meta-analysis to evaluate the effect of anticoagulation therapy in patients with cirrhosis and PVT.
Methods

PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched (until 31st October 2020) for studies evaluating the effect of anticoagulation therapy on treating PVT in patients with cirrhosis. Odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using the Mantel–Haenszel method.
Results

A total of 13 studies were included in the analysis, comprising 6005 patients. Of these, three were prospective cohort studies, nine were retrospective cohort studies and one was case–control study. Compared to no treatment, anticoagulation therapy was associated with higher rates of PVT recanalization (OR 4.29; 95% CI 3.01–6.13). Anticoagulation therapy demonstrated a significant 74% reduction in PVT extension compared to no treatment (OR 0.26; 95% CI 0.14–0.49). Anticoagulation therapy was associated with a nonsignificantly lower risk of death (OR 0.53; 95% CI 0.20–1.40). However, anticoagulation therapy was associated with slightly higher risk of bleeding compared to no treatment (OR 1.16; 95% CI 1.02–1.32).
Conclusions

In cirrhotic patients with PVT, anticoagulation therapy helps increase rate of PVT recanalization and improve survival, but may also carry higher risks of bleeding compared to no treatment. Our findings support the use of anticoagulation in cirrhotic patients with PVT.