| BackgroundCurrently,there are no guidelines or consensus on the optimal management of portal vein thrombosis(PVT)in cirrhotic patients after gastric varices(GV)endoscopic cyanoacrylate injection(ECI).Although meta-analyses have demonstrated that anticoagulation therapy can improve recanalization in patients with cirrhotic PVT,there are inconsistent results on bleeding risk.Whether anticoagulation therapy increases bleeding episodes caused by glue cast extrusion is also unclear.This study aimed to verify the effect of anticoagulation treatment on the risk of bleeding after ECI for GV in PVT patients with liver cirrhosis.MethodsEligible patients from Qilu Hospital of Shandong University,Shandong Provincial Hospital,and Taian City Central Hospital between January 2015 and April 2022 were included and assigned to the anticoagulation group or the control group.The baseline data of the two groups were matched by performing propensity score matching(PSM)at a ratio of 1:1.Patients in the anticoagulation group initiated anticoagulation within 1 week after ECI and were divided into two subgroups according to the time of initiation:the early anticoagulation group,in which the anticoagulation was initiated within 48 h after tissue adhesive injection,and the delayed anticoagulation group,in which the anticoagulation was started after 48 h after ECI.The primary endpoint was the incidence of a bleeding episode caused by glue cast extrusion.The secondary endpoint was cirrhosis-related mortality during the 1-year follow-up.The severity of bleeding related to glue extrusion and the change of liver function were also compared between the anticoagulation and control groups.ResultsA total of 177 patients were included and assigned to the anticoagulation group or the control group.After PSM,43 patients were included in each group.The rates of 6-month(before PSM:6.8%vs 18.6%,P=0.036;after PSM:7.0%vs 23.3%,P=0.035)and 1-year(before PSM:6.8%vs 21.2%,P=0.015;after PSM:7.0%vs 25.6%,P=0.019)bleeding due to glue cast extrusion in the anticoagulation group were significantly lower than that in the control group.However,the rate of 6-week bleeding related to glue cast extrusion between the two groups were similar(before PSM:1.7%vs 7.6%,P=0.168;after PSM:2.3%vs 7.0%,P=0.616).The cumulative risk of bleeding caused by glue cast extrusion was significantly higher in the control group during the follow-up(before PSM:Log-rank P=0.016;after PSM:Log-rank P=0.020).Patients with and without anticoagulation therapy did not differ significantly in the duration of stay in intensive care unit(ICU),the occurrence of hemorrhagic shock,the number of episodes requiring red blood cell(RBC)transfusion,number of RBC transfusion units,the duration of hospitalization,or mortality either before or after PSM.The multivariate Cox regression analysis before PSM revealed that anticoagulation therapy(HR=0.326,95%CI=0.110-0.961,P=0.042),serum albumin<30 g/L(HR=2.371,95%CI=1.061-5.297,P=0.035),and tissue adhesive dosage(HR=1.190,95%CI=1.038-1.365,P=0.013)were independent factors predicting the risk of bleeding caused by glue cast extrusion.After PSM,only anticoagulation therapy(HR=0.235,95%CI=0.059-0.939,P=0.040)and serum albumin<30 g/L(HR=5.777,95%CI=1.663-20.062,P=0.006)were significantly associated with the risk of bleeding due to glue cast extrusion.The rates of 6-week(4.0%vs 0%,P=0.424),6-month(4.0%vs 8.8%,P=0.630),and 1-year(4.0%vs 8.8%,P=0.630)bleeding related to glue cast extrusion were similar between the early and delayed anticoagulation groups.The serum albumin level and Child-Pugh score improved in the anticoagulation group at both early and late follow-ups.ConclusionAnticoagulation therapy could independently decrease the risk of bleeding caused by glue cast extrusion after ECI and there was no increase in the severity of bleeding.Anticoagulation may also improve hepatic function.Early initiation of anticoagulation treatment after ECI(<48 h)was safe. |
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