SynthesisClinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
Comparative Effectiveness and Safety of Various Anticoagulation Regimens for Portal Venous Thrombosis in Cirrhosis: A Systematic Review and Network Meta-Analysis.
Synthesis in Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
BackgroundPortal venous thrombosis (PVT) is a serious complication in cirrhosis, with management debated due to differing anticoagulant guidelines. This network meta-analysis assessed various anticoagulants for PVT in cirrhotic patients.MethodsPubMed, Cochrane Central, and ScienceDirect were searched till May 2025. A frequentist network meta-analysis was conducted in RStudio version 4.3.3. The ranking was based on P-scores.ResultsNineteen studies were included in the analysis. Direct oral anticoagulants (DOACs) (RR = 2.38; 95%CI:[1.17, 4.85]; p = 0.02), fondaparinux (RR = 18.16; 95%CI:[2.09, 158.13]; p = 0.009), low-molecular-weight heparin (LMWH) (RR = 11.96; 95%CI:[1.58, 90.79]; p = 0.01), LMWH-Warfarin sequential therapy (RR = 2.32; 95%CI:[1.01, 5.31]; p = 0.04), and Vitamin K antagonists (VKA) (RR = 1.71; 95%CI:[1.03, 2.83]; p = 0.04) showed a significant increase in complete recanalization, with fondaparinux ranked highest (P-score = 0.94). DOACs (RR = 0.23;95%CI:[0.07, 0.71]; p = 0.01), LMWH (RR = 0.24;95%CI:[0.11, 0.52]; p = 0.0003), LMWH-Warfarin sequential therapy (RR = 0.40;95%CI:[0.21, 0.77]; p = 0.006) demonstrated a significant reduction in PVT progression, with Antithrombin-III ranked highest (P-score = 0.87). Fondaparinux was ranked highest (P-score = 0.90) for reducing esophageal variceal bleeding, while LMWH was ranked highest (P-score = 0.72) for decreasing overall bleeding. DOACs significantly decreased mortality (RR = 0.74; 95% CI: [0.67, 0.81]; p < 0.0001), with LMWH ranked highest (P-score = 0.80) for mortality.ConclusionDOACs, LMWH, and LMWH-Warfarin sequential therapy significantly improved recanalization and reduced PVT progression. LMWH was ranked highest in reducing bleeding and mortality, while fondaparinux ranked highest regarding esophageal bleeding and complete recanalization.
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