The Efficacy And Safety Of Anticoagulation In Patients Cirrhosis With Portal Vein Thrombosis:a Systematic Review And Meta-analysis Of Observational Studies

Objeetive:To evaluate the safety and efficacy of anticoagulation for the treatment of portal vein thrombosis(PVT)in cirrhotic patients.Method:We searchedstudies in the electronic databases including CNKI,WANFANOVIP,Pubmed,Medl-ine,Cochran e Library.Searching the related literatures aboutcomparison of safety and efficacyof new oral anticoagulant drugs with warfarin.Quality assessment was investigated ac cording to the design,rate of stroke death rate,risk of bleeding.Odds ratio(OR),risk r atio(RR),and 95%confidence interval(95%CI)were calculated using the fixed effects and random effects.Results:Twenty-two of 1506 initially ident-ified papers were incl uded.All are English literature,no Chinese literature,and all are observational studi es.Between different research chooses the sample are larger gap duration,and follow up time.11 articles were reported after anticoagulation complications,such as bleedi ng,deterioration of liver cirrhosis,portal vein thrombosis progress adverse outcomes,but no fatal incident.Article 8 retrospective study of anticoagulant related complicati ons was 3%-30%,no serious bleeding events report.Anticoagulation related complicat ions incidence of 9%(95% CI=5.1%-12.9%).Heterogeneity between studies was stat istically significant(P=0.999;I2=68.4%,68.4% CI=0%,56.3%).14 in observational st udies of anticoagulant related complications of 0%-14.3%.Point incidence was 3.3%(95%% CI=95%-1.1%).Heterogeneity-test had statistical significance(?=0.018,I2=53.5%,95% CI 0% to 74.9%).Lite-rature research cases anticoagulation after the incid ence of portal venous recanaliz-ation was 36%-36%,anticoagulation after recanalizati on rates were high.Anticoa-gulation related recanalization rate 76%(95% CI = 73%to 79%).Study heterogen-eity between no statistical significance(?<0.0001,I2=77.5%,95% CI=95%-0%).12 articles anticoagulation after portal vein completely recanalizat ion rate of 0%-75%,anticoagulation with a higher rate of recanalization.Anticoagulat ion related complete recanalization rate 41.5%(95% CI = 29.2% to 54.5%).The he terogeneity between studies was statistically significant(P < 0.001;I2 = 82.2%,95% CI = 95%,68.8%).Article 8 retrospective study of 204 patients,according to t he results,P=0.371,I2=7.7%,no obvious heterogeneity between studies,so take a fix ed effect model results.After cut to fill the merge point estimates and 95% confide nce interal,3.966(2.269,6.932)and cut before 5.342(3.084,3.084),there was no st atistically significant difference.Conclusions:Anticoagulation could achieve a relativel y high rate of portal vein recanalization in cirrhotic patients with PVT.Given that only a small number of non-randomized comparative studies are reported,randomiz ed con-trolled trials are warranted to confirm the risk-to-benefit of anticoagulation in such patients,especially anticoagulation-related bleeding.