Efficacy and Safety of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta‐Analysis of Randomized and Non‐Randomized Studies

ABSTRACT Background Portal vein thrombosis (PVT) contributes substantially to morbidity and mortality in cirrhotic patients. A clear insight into the anticoagulation therapy benefits in these patients could improve clinical decision‐making. This meta‐analysis aimed to assess the efficacy and safety of Anticoagulants in cirrhotic patients with PVT. Methods PubMed, Cochrane Library, and ScienceDirect were searched from inception to September 2024. The Risk Ratios (RR) with 95% Confidence Interval (CI) were pooled for dichotomous outcomes under the random effects model using Review Manager 5.4.1. The primary endpoint of interest is PVT recanalization. Quality assessment was done through the Newcastle Ottawa Scale and the Cochrane RoB2.0 tool. Leave‐one‐out sensitivity analysis was done to investigate the cause of heterogeneity. Publication bias was assessed through funnel plots. Results Twenty‐three studies (including 19 cohorts and 4 Randomized trials), pooling 81,599 patients, were included in the analysis. Anticoagulants significantly increased the PVT recanalization (RR = 2.00; 95% CI: [1.59, 2.52]; p < 0.00001; I 2 = 13%), PVT improvement (RR = 1.98; 95% CI: [1.70, 2.29], p < 0.00001; I 2 = 0%) while decreasing the PVT stability (RR = 0.78; 95% CI: [0.62,0.99], p = 0.04; I 2 = 19%) and PVT progression (RR = 0.42; 95% CI: [0.29, 0.60], p < 0.00001; I 2 = 27%). Other outcomes including mortality (RR = 0.53; 95% CI: [0.27, 1.03]; p = 0.06; I 2 = 94%), total bleeding (RR = 1.02; 95% CI: [0.76, 1.37], p = 0.89; I 2 = 31%), esophageal variceal bleeding (RR = 0.74; 95% CI: [0.54, 1.01], p = 0.06; I 2 = 56%), Gastrointestinal bleeding (RR = 1.07; 95% CI: [0.78, 1.48]; p = 0.66, I 2 = 13%) and Intracranial hemorrhage (RR = 1.19; 95% CI: [0.89, 1.58], p = 0.24, I 2 = 0%) were comparable between the 2 arms. Conclusion Anticoagulants significantly increased PVT recanalization and PVT improvement while decreasing PVT stability and PVT progression in cirrhotic patients. Other outcomes were comparable between the two groups.