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Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database
  1. Zahid Ijaz Tarar1,
  2. Umer Farooq2,
  3. Faisal Kamal3,
  4. Ahmad Nawaz4,
  5. Saad Saleem5,
  6. Ghulam Ghous1,
  7. Omer Basar6,
  8. Harleen Kaur Chela7,
  9. Veysel Tahan6,
  10. Ebubekir Daglilar6
  1. 1Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
  2. 2Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
  3. 3Gastroenterology, University of California San Francisco, San Francisco, California, USA
  4. 4Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  5. 5Internal Medcine, Sunrise Hospital and Medical Center, Las Vegas, Nevada, USA
  6. 6Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
  7. 7Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
  1. Correspondence to Dr Zahid Ijaz Tarar, Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA; drzahidejaz{at}hotmail.com

Abstract

Background and aim Anticoagulation use for portal vein thrombosis (PVT) in patients with advanced liver disease is controversial. We investigated the effect of anticoagulation on outcomes in patients with PVT with cirrhosis.

Methods We reviewed National Inpatient Sample data from 2016 to 2018 to identify patients with PVT. Our outcomes were in-hospital mortality, variceal bleeding, hepatic encephalopathy, acute kidney injury (AKI), hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), sepsis and hospital resource utilisation.

Results We included 60 505 patients with PVT, out of whom 6.63% (4015) were on anticoagulation. The overall mortality in the anticoagulation group was 2.12% compared with 9.72% in the no anticoagulation group. The adjusted odds of mortality were low in the anticoagulation group (adjusted OR (AOR) 0.27, 95% CI 0.15 to 0.46, p<0.001). Patients on anticoagulation had 29% lower odds of variceal bleeding (AOR 0.71, 95% CI 0.53 to 0.96, p=0.03). Lower odds of HRS (AOR 0.56, 95% CI 0.37 to 0.85, p=0.01) and AKI (AOR 0.57, 95% CI 0.48 to 0.69, p<0.001) were also seen in the anticoagulation group. Patients in the anticoagulation group also showed lower odds of SBP (AOR 0.62, 95% CI 0.43 to 0.89, p=0.01) and sepsis (AOR 0.57, 95% CI 0.35 to 0.93, p=0.03). Anticoagulation use resulted in shorter hospital stay by 1.15 days (adjusted length of stay −1.15, 95% CI −1.51 to –0.79, p<0.001). The mean difference in total hospital charges between the anticoagulation and the no anticoagulation group was −$20 034 (95% CI −$27 077 to −$12 991, p<0.001).

Conclusion Our analysis found that anticoagulation use is safe and associated with better outcomes in patients with PVT with advanced liver disease.

  • Hepatobiliary disease
  • Endoscopy

Data availability statement

Data are available upon reasonable request. We performed our study on the National Inpatient Sample (NIS), the largest, publicly available, all-payer inpatient database maintained by the Agency of Health Care and Utilization. We will provide data on request after approval from the Agency of Healthcare Cost and Utilization Project.

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Data availability statement

Data are available upon reasonable request. We performed our study on the National Inpatient Sample (NIS), the largest, publicly available, all-payer inpatient database maintained by the Agency of Health Care and Utilization. We will provide data on request after approval from the Agency of Healthcare Cost and Utilization Project.

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Footnotes

  • Contributors ZIT, UF, FK, SS, ED, VT: concept and design of the study, data collection, data analysis, interpretation of results, writing of the manuscript, and final revision. HKC, GG, OB, AN: interpretation of results and manuscript writing. All authors approved the final version of the manuscript. ZIT: responsible for the overall content and guarantor of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.