| Objective: To study the safety and effectiveness of anticoagulant therapy for patients with liver cirrhosis(LC)complicated with portal vein thrombosis(PVT)by Meta-analysis(MA).Methods:Using "cirrhosis,anticoagulation,portal vein thrombosis" and its English as search terms,Relevant literatures on anticoagulant therapy for patients with LC complicated with PVT were retrieved in databases,with the retrieval scope of four English databases(pubmed,web of science,Embase and Cochrane Library)and three Chinese databases(CNKI,Wanfang database,VIP database),and the retrieval time is from 1950 to June 2019.All literatures were managed by Endnote software and selected one by one according to the inclusion and exclusion criteria,and literatures meeting the inclusion criteria were included in this study.The basic characteristics and relevant data of the literatures were extracted in turn,and the qualities of the literatures were evaluated.The indicators of evaluation effectiveness are: total recanalization rate,non-response rate,and rate of progress,and recanalization is divided into three subgroups: complete recanalization,partial recanalization,and undifferentiated recanalization;the indicators for evaluating safety are: total bleeding Rate and mortality,the bleeding is divided into two subgroups of variceal bleeding and non-varicose bleeding.Finally,MA was conducted on the data by Review Manager 5.3software.Results: 8 cases were finally included for comparation in this study.The overall qualityof the literature was good.There was a total of 649 patients diagnosed as LC complicated with PVT,including 316 patients in the anticoagulant therapy group and 333 patients in the non-anticoagulant therapy group.The MA results were as follows:1.Eight studies reported the total recanalization of thrombus in both groups of patients.The results showed that the total recanalization rate of thrombus in the anticoagulant therapy group was significantly higher than that in the non-anticoagulant therapy group [OR=4.73,95%CI(3.33,6.73),Z = 8.65(P < 0.00001)],with statistically significant difference.2.Four studies put forward the complete recanalization of thrombus in both groups clearly.Subgroup analysis results showed that the complete recanalization rate of the anticoagulant therapy group was significantly higher than that of the non-anticoagulant therapy group [OR=4.93,95% CI(2.67,9.12),Z = 5.09(P < 0.0001)];Two studies put forward the partial recanalization of thrombus.Subgroup analysis results showed that there was no significant difference in the partial recanalization rate between the anticoagulant therapy group and the non-anticoagulant therapy group [OR =1.75,95% CI(0.84,3.66),Z=1.50(P=0.13)];Four studies did not distinguish between the complete recanalization and the partial recanalization of thrombus,and were classified into the undifferentiated recanalization subgroup.The results showed that the undifferentiated recanalization rate of the anticoagulant therapy group was significantly higher than that of the non-anticoagulant therapy group [OR=4.62,95% CI(2.92,7.33),Z = 6.52(P < 0.0001)].3.Four studies reported the situation of no response to thrombus in both groups.The results showed that the no-response rate of thrombus in the anticoagulant therapy group was significantly lower than that in the non-anticoagulant therapy group [OR=0.32,95% CI(0.19,0.53),Z = 4.43(P < 0.00001)].4.Four studies pointed out the thrombus progress in both groups clearly.The results showed that the thrombus progress rate in the anticoagulant therapy group was significantly lower than that in the non-anticoagulant therapy group [OR=0.21,95%CI(0.06,0.70),Z=2.55(P=0.01)].5.A total of seven studies reported the total bleeding events of both groups of patients.Itwas found that the total bleeding rate of PVT patients in the anticoagulant therapy group was lower than that in the non-anticoagulant therapy group [OR=0.47,95% CI(0.28,0.78),Z=2.88(P=0.004)],with statistically significant difference.6.Three studies put forward the variceal bleeding in both groups of patients clearly.Subgroup analysis results showed that the variceal bleeding rate in the anticoagulant therapy group was lower than that in the non-anticoagulant therapy group [OR =0.23,95% CI(0.09,0.60),Z =3.00(P=0.003)];Three studies put forward the non-variceal hemorrhage.Sub-group analysis results showed that there was no significant difference in the non-variceal hemorrhage rate between the two groups [OR =2.21,95% CI(0.86,5.67),Z =1.66(P=0.10)].7.Three studies mentioned mortality.The results showed that the mortality of PVT patients in the anticoagulant therapy group was lower than that in the non-anticoagulant therapy group [OR=0.24,95% CI(0.08,0.78),Z=2.37(P=0.02)],with statistically significant difference.Conclusion: For patients with cirrhosis and PVT,anticoagulant therapy can increase the thrombosis recanalization rate and reduce the non-response rate and progression rate.At the same time,it will not only increase the risk of bleeding,but will reduce the total bleeding rate,especially the varicose bleeding rate.Anticoagulation therapy also reduce the mortality of PVT patients. |
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