Comparative effectiveness of warfarin in cirrhotic patients with non-symptomatic portal vein thrombosis: a multicenter, randomized controlled trial.

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Expert Review of Gastroenterology & Hepatology Pub Date : 2024-01-01 Epub Date: 2024-01-29 DOI:10.1080/17474124.2024.2307575

Shenxin Lu, Jie Chen, Rui Zhang, Tiancheng Luo, Lili Ma, Pengju Xu, Hong Ding, Xiaoqing Zeng, Bing Wu, Yihai Shi, Chenghai Liu, Yongping Mu, Shiyao Chen, Jian Wang

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Abstract

The effectiveness and risks of anticoagulant therapy in cirrhotic patients with non-symptomatic portal vein thrombosis (PVT) remain unclear. We conducted a multicenter, Zelen-designed randomized controlled trial to determine the effectiveness of warfarin in cirrhotic patients with non-symptomatic PVT during a one-year follow-up. In brief, 64 patients were 1:1 randomly divided into the anticoagulation group or the untreated group. The probability of recanalization was significantly higher in the anticoagulation group than those untreated in both ITT analysis (71.9% vs 34.4%, p = 0.004) and PP analysis (76.7% vs 32.4%, p < 0.001). Anticoagulation treatment was the independent predictor of recanalization (HR 2.776, 95%CI 1.307-5.893, p = 0.008). The risk of bleeding events and mortality were not significantly different. A significantly higher incidence of ascites aggravation was observed in the untreated group (3.3% vs 26.5%, p = 0.015). In conclusion, warfarin was proved to be an effective and safe as an anticoagulation therapy for treating non-symptomatic PVT in cirrhotic patients.

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华法林对无症状门静脉血栓形成的肝硬化患者的疗效比较：一项多中心随机对照试验。

抗凝疗法对无症状门静脉血栓形成（PVT）肝硬化患者的有效性和风险仍不明确。我们开展了一项由 Zelen 设计的多中心随机对照试验，以确定华法林在肝硬化非症状性门静脉血栓患者一年随访期间的有效性。简而言之，64 名患者按 1:1 随机分为抗凝组和未治疗组。在 ITT 分析（71.9% 对 34.4%，P = 0.004）和 PP 分析（76.7% 对 32.4%，P = 0.008）中，抗凝组的再通畅概率明显高于未治疗组。出血事件和死亡风险无明显差异。未治疗组腹水加重的发生率明显更高（3.3% vs 26.5%，P = 0.015）。总之，华法林被证明是治疗肝硬化患者无症状 PVT 的一种有效、安全的抗凝疗法。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.