The Efficacy And Safety Of Anticoagulants In Patients With Cirrhosis:A Meta-analysis

Objective:Published clinical studies on anticoagulant therapy(traditional or new oral anticoagulant(NOAC))in patients with cirrhosis were collected for Meta-analysis to evaluate the efficacy and safety of anticoagulant therapy in patients with cirrhosis.Methods:According to the literature retrieval strategy,the anticoagulant therapy for cirrhosis was searched in Pub Med Cochrane Embase Web of Science Wanfangweip CBM database.Key Chinese keywords include chronic liver disease,cirrhosis,portal vein thrombosis,new oral anticoagulants,direct oral anticoagulants,anticoagulant therapy.Main English search terms include liver cirrhosis,hepatic cirrhosis,portal vein thrombosis,venous thrombosis of portal,New oral anticoagulants,Direct Oral anticoagulants,anticoagulants.The retrieved literatures were screened one by one,and the quality of the included literatures was evaluated and the data were extracted.Meta-analysis was performed using Rev Man 5.4.1 softwareResults:A total of 3229 literatures were retrieved and selected according to inclusion and exclusion criteria.Sixteen articles were included,including 2 randomized controlled trials and 14 cohort studies.The results of literature quality evaluation indicate that the literature quality is reliable.The results showed:1.For patients with cirrhosis complicated with portal vein thrombosis,the recirculation rate of portal vein thrombosis increased after anticoagulant therapy.[RR=2.89,95%CI(2.19,3.82),Z=7.48,P < 0.00001];2.In terms of bleeding risk,the incidence of bleeding events in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy was similar to that without anticoagulation.[RR=0.71,95%CI(0.46,1.09),Z=1.57,P=0.12>0.05];3.Comparing the clinical results of NOAC with traditional anticoagulants in patients with cirrhosis,the recirculation rate of portal vein thrombosis in NOAC group was higher than that in the traditional anticoagulant group.[RR=2.42,95%CI (1.80,3.24),Z=5.92,P < 0.00001];4.The incidence of bleeding events in patients with cirrhosis was not significantly different from that in the traditional anticoagulant group.[RR=0.71,95%CI (0.47,1.07),Z=1.63,P=0.10>0.05];Conclusion:Anticoagulant therapy for patients with cirrhosis complicated with portal vein thrombosis is safe and effective.Further analysis showed that there was no significant difference in bleeding risk between the new oral anticoagulant and the traditional anticoagulants(heparin/warfarin),and the rate of thrombus recanalization was better than that of the traditional anticoagulant.However,due to the lack of large sample randomized controlled trials,the accuracy of the results need to be further verified.