Anticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: The IMPORTAL competing-risk meta-analysis
Abstract
BACKGROUND & AIMS
Previous meta-analyses demonstrated the safety and efficacy of anticoagulation in the recanalization of portal vein thrombosis in patients with cirrhosis. Whether this benefit translates into improved survival is unknown. We conducted an individual patient data (IPD) meta-analysis to assess the effect of anticoagulation on aal-cause mortality in cirrhosis with portal vein thrombosis.
METHODS
In this IPD meta-analysis, we selected studies comparing anticoagulation vs. no treatment in cirrhosis with portal vein thrombosis from PubMed, Embase, and Cochrane databases (until June 2020) (PROSPERO no.: CRD42020140026). IPD were subsequently requested from authors. The primary outcome-the effect of anticoagulation on all-cause mortality-was assessed by a one-step meta-analysis based on a competing risk model with liver transplantation as the competing event. The model was adjusted for clinically relevant confounders. A multilevel mixed-effects logistic regression model was used to determine the effect of anticoagulation on recanalization.
RESULTS
Individual data of 500 patients from 5 studies were included; 205 (41%) received anticoagulation and 295 did not. Anticoagulation reduced all-cause mortality (adjusted subdistribution hazard ratio=0.59; 95%CI 0.49, 0.70), independently of thrombosis severity and recanalization. The effect of anticoagulation on all-cause mortality was consistent with reduction in liver-related mortality. The recanalization rate was higher…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 500 participants or records.
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