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Anticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: The IMPORTAL competing-risk meta-analysis

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dc.contributor.authorGuerrero, Antonio
dc.contributor.authorCampo, Laura del
dc.contributor.authorPiscaglia, Fabio
dc.contributor.authorScheiner, Bernhard
dc.contributor.authorHan, Guohong
dc.contributor.authorVioli, Francesco
dc.contributor.authorFerreira, Carlos
dc.contributor.authorTéllez, Luis
dc.contributor.authorReiberger, Thomas
dc.contributor.authorBasili, Stefania
dc.contributor.authorZamora, Javier
dc.contributor.authorAlbillos, Agustín
dc.contributor.authorValla, Dominique
dc.contributor.authorDurand, Francois
dc.contributor.authorArtaza, Tomás
dc.contributor.authorGarcía-Pagán, Juan Carlos
dc.contributor.authorMagaz, Marta
dc.contributor.authorLa Mura, Vincenzo
dc.contributor.authorPrimignani, Massimo
dc.contributor.authorLuca, Angelo
dc.contributor.authorStanciu, Carol
dc.contributor.authorSenzolo, Marco
dc.contributor.authorAmitrano, Lucio
dc.contributor.authorStefanescu, Horia
dc.contributor.authorNery, Filipe
dc.contributor.authorChevret, Sylvie
dc.contributor.authorGirleanu, Irina
dc.date.accessioned2023-07-18T11:26:36Z
dc.date.available2023-07-18T11:26:36Z
dc.date.issued2023
dc.description© 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reservedpt_PT
dc.description.abstractBackground & aims: Previous meta-analyses demonstrated the safety and efficacy of anticoagulation in the recanalization of portal vein thrombosis in patients with cirrhosis. Whether this benefit translates into improved survival is unknown. We conducted an individual patient data (IPD) meta-analysis to assess the effect of anticoagulation on all-cause mortality in patients with cirrhosis and portal vein thrombosis. Methods: In this IPD meta-analysis, we selected studies comparing anticoagulation vs. no treatment in patients with cirrhosis and portal vein thrombosis from PubMed, Embase, and Cochrane databases (until June 2020) (PROSPERO no.: CRD42020140026). IPD were subsequently requested from authors. The primary outcome - the effect of anticoagulation on all-cause mortality - was assessed by a one-step meta-analysis based on a competing-risk model with liver transplantation as the competing event. The model was adjusted for clinically relevant confounders. A multilevel mixed-effects logistic regression model was used to determine the effect of anticoagulation on recanalization. Results: Individual data on 500 patients from five studies were included; 205 (41%) received anticoagulation and 295 did not. Anticoagulation reduced all-cause mortality (adjusted subdistribution hazard ratio 0.59; 95% CI 0.49-0.70), independently of thrombosis severity and recanalization. The effect of anticoagulation on all-cause mortality was consistent with a reduction in liver-related mortality. The recanalization rate was higher in the anticoagulation arm (adjusted odds ratio 3.45; 95% CI 2.22-5.36). The non-portal-hypertension-related bleeding rate was significantly greater in the anticoagulation group. Conclusions: Anticoagulation reduces all-cause mortality in patients with cirrhosis and portal vein thrombosis independently of recanalization, but at the expense of increasing non-portal hypertension-related bleeding. Prospero registration number: CRD42020140026. Impact and implications: Anticoagulation is effective in promoting recanalization of portal vein thrombosis in patients with cirrhosis, but whether this benefit translates into improved survival is controversial. Our individual patient data meta-analysis based on a competing-risk model with liver transplantation as the competing event shows that anticoagulation reduces all-cause mortality in patients with cirrhosis and portal vein thrombosis independently of recanalization. According to our findings, portal vein thrombosis may identify a group of patients with cirrhosis that benefit from long-term anticoagulation.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Hepatol. 2023 Jul;79(1):69-78pt_PT
dc.identifier.doi10.1016/j.jhep.2023.02.023pt_PT
dc.identifier.eissn1600-0641
dc.identifier.issn0168-8278
dc.identifier.urihttp://hdl.handle.net/10451/58650
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/journal-of-hepatologypt_PT
dc.subjectAnticoagulationpt_PT
dc.subjectCirrhosispt_PT
dc.subjectPortal veinpt_PT
dc.subjectThrombosispt_PT
dc.titleAnticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: The IMPORTAL competing-risk meta-analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage78pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPage69pt_PT
oaire.citation.titleJournal of Hepatologypt_PT
oaire.citation.volume79pt_PT
person.familyNameNoronha Ferreira
person.givenNameCarlos
person.identifier.ciencia-id841F-23ED-7A1D
person.identifier.orcid0000-0002-7169-544X
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication1fca72b3-aee8-4fa3-a9c2-7cbbd93a6dd4
relation.isAuthorOfPublication.latestForDiscovery1fca72b3-aee8-4fa3-a9c2-7cbbd93a6dd4

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