Abstract：
BACKGROUND: Portal vein thrombosis in cirrhotic patients presents a significant clinical challenge. This study aims to (1) explore the impact of anticoagulation therapy on patient outcomes; (2) comparative outcomes in portal vein thrombosis treated between direct oral anticoagulant and Vitamin K Antagonist (VKA).
METHODS: We leveraged the TriNetX database to analyze a cohort comprising 4224 patients with liver cirrhosis and PVT who were treated with anticoagulation, alongside a comparison group of 15,300 patients with the same conditions but not receiving anticoagulation therapy.
RESULTS: The anticoagulated group showed a significant reduction in mortality (27.9 % vs. 34.2 %, HR = 0.723, 95 % CI: 0.678-0.770, P < 0.001). When comparing direct oral anticoagulant versus. VKA, in compensated liver cirrhosis, the direct oral anticoagulant group exhibited significantly lower mortality rates compared to VKA (17.7 % vs. 26.5 %, HR = 0.655, 95 % CI: 0.452-0.951, P = 0.025), with no significant difference in liver transplantation rates (4.0 % vs. 4.7 %, P = 0.080). In decompensated liver cirrhosis, the direct oral anticoagulant group exhibited lower mortality compared to the VKA group (23.6 % vs. 30.6 %, HR = 0.732, 95 % CI: 0.629-0.851, P < 0.001), and a higher frequency of liver transplantation was observed in the VKA group (10.6 % vs. 16.0 %, HR = 0.622, 95 % CI: 0.494-0.784, P < 0.001). Hospitalization rates were significantly lower in the direct oral anticoagulant group compared to the VKA group in decompensated cirrhosis (33.4 % vs. 38.3 %, HR = 0.830, 95 % CI: 0.695-0.992, P = 1.937).
CONCLUSIONS: Our study offers compelling evidence supporting the use of anticoagulation therapy in liver cirrhosis with portal vein thrombosis. The use of DOACs in patients with both compensated and decompensated liver cirrhosis showed a marked mortality benefit.
METHODS: We leveraged the TriNetX database to analyze a cohort comprising 4224 patients with liver cirrhosis and PVT who were treated with anticoagulation, alongside a comparison group of 15,300 patients with the same conditions but not receiving anticoagulation therapy.
RESULTS: The anticoagulated group showed a significant reduction in mortality (27.9 % vs. 34.2 %, HR = 0.723, 95 % CI: 0.678-0.770, P < 0.001). When comparing direct oral anticoagulant versus. VKA, in compensated liver cirrhosis, the direct oral anticoagulant group exhibited significantly lower mortality rates compared to VKA (17.7 % vs. 26.5 %, HR = 0.655, 95 % CI: 0.452-0.951, P = 0.025), with no significant difference in liver transplantation rates (4.0 % vs. 4.7 %, P = 0.080). In decompensated liver cirrhosis, the direct oral anticoagulant group exhibited lower mortality compared to the VKA group (23.6 % vs. 30.6 %, HR = 0.732, 95 % CI: 0.629-0.851, P < 0.001), and a higher frequency of liver transplantation was observed in the VKA group (10.6 % vs. 16.0 %, HR = 0.622, 95 % CI: 0.494-0.784, P < 0.001). Hospitalization rates were significantly lower in the direct oral anticoagulant group compared to the VKA group in decompensated cirrhosis (33.4 % vs. 38.3 %, HR = 0.830, 95 % CI: 0.695-0.992, P = 1.937).
CONCLUSIONS: Our study offers compelling evidence supporting the use of anticoagulation therapy in liver cirrhosis with portal vein thrombosis. The use of DOACs in patients with both compensated and decompensated liver cirrhosis showed a marked mortality benefit.
摘要：
背景：肝硬化患者的门静脉血栓形成是一个重要的临床挑战。本研究旨在（1）探讨抗凝治疗对患者预后的影响；（2）直接口服抗凝剂和维生素K拮抗剂（VKA）治疗门静脉血栓形成的比较结果。
方法：我们利用TriNetX数据库分析了一个包含4224例接受抗凝治疗的肝硬化和PVT患者的队列，与对照组的15,300例具有相同条件但未接受抗凝治疗的患者一起。
结果：抗凝组的死亡率显着降低（27.9%vs.34.2%,HR=0.723,95%CI:0.678-0.770,P<0.001)。当比较直接口服抗凝剂时。VKA,在代偿性肝硬化中，与VKA相比，直接口服抗凝药组的死亡率显着降低（17.7％vs.26.5%,HR=0.655,95%CI:0.452-0.951,P=0.025),肝移植率无显著差异(4.0%vs.4.7%，P=0.080)。在失代偿期肝硬化中，与VKA组相比，直接口服抗凝剂组的死亡率较低(23.6%vs.30.6%,HR=0.732,95%CI:0.629-0.851,P<0.001),在VKA组中观察到更高的肝移植频率（10.6％vs.16.0%,HR=0.622,95%CI:0.494-0.784,P<0.001)。在失代偿期肝硬化患者中，直接口服抗凝剂组的住院率明显低于VKA组（33.4%vs.38.3%,HR=0.830,95%CI:0.695-0.992,P=1.937)。
结论：我们的研究提供了有力的证据支持在肝硬化门静脉血栓形成中使用抗凝治疗。在代偿和失代偿肝硬化患者中使用DOAC显示出明显的死亡率益处。
方法：我们利用TriNetX数据库分析了一个包含4224例接受抗凝治疗的肝硬化和PVT患者的队列，与对照组的15,300例具有相同条件但未接受抗凝治疗的患者一起。
结果：抗凝组的死亡率显着降低（27.9%vs.34.2%,HR=0.723,95%CI:0.678-0.770,P<0.001)。当比较直接口服抗凝剂时。VKA,在代偿性肝硬化中，与VKA相比，直接口服抗凝药组的死亡率显着降低（17.7％vs.26.5%,HR=0.655,95%CI:0.452-0.951,P=0.025),肝移植率无显著差异(4.0%vs.4.7%，P=0.080)。在失代偿期肝硬化中，与VKA组相比，直接口服抗凝剂组的死亡率较低(23.6%vs.30.6%,HR=0.732,95%CI:0.629-0.851,P<0.001),在VKA组中观察到更高的肝移植频率（10.6％vs.16.0%,HR=0.622,95%CI:0.494-0.784,P<0.001)。在失代偿期肝硬化患者中，直接口服抗凝剂组的住院率明显低于VKA组（33.4%vs.38.3%,HR=0.830,95%CI:0.695-0.992,P=1.937)。
结论：我们的研究提供了有力的证据支持在肝硬化门静脉血栓形成中使用抗凝治疗。在代偿和失代偿肝硬化患者中使用DOAC显示出明显的死亡率益处。
