1. A pilot study of safety and efficacy comparison of low molecular heparin calcium sequential oral anticoagulants in the treatment of cirrhotic portal vein thrombosis.
- Author
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Zhang J, Dang X, Zhang L, and Li W
- Subjects
- Humans, Pilot Projects, Male, Female, Middle Aged, Administration, Oral, Treatment Outcome, Aged, Factor Xa Inhibitors adverse effects, Factor Xa Inhibitors administration & dosage, Factor Xa Inhibitors therapeutic use, Adult, Injections, Subcutaneous, Tomography, X-Ray Computed, Drug Therapy, Combination, Anticoagulants administration & dosage, Anticoagulants adverse effects, Anticoagulants therapeutic use, Rivaroxaban administration & dosage, Rivaroxaban adverse effects, Rivaroxaban therapeutic use, Portal Vein diagnostic imaging, Venous Thrombosis drug therapy, Venous Thrombosis diagnostic imaging, Liver Cirrhosis complications, Liver Cirrhosis drug therapy, Warfarin administration & dosage, Warfarin adverse effects, Heparin, Low-Molecular-Weight administration & dosage, Heparin, Low-Molecular-Weight therapeutic use, Heparin, Low-Molecular-Weight adverse effects
- Abstract
Background: The objective of this study is to compare and assess the efficacy and safety of low-molecular-weight heparin calcium (LMWH-Ca), followed by either warfarin or rivaroxaban, as treatment options for portal vein thrombosis (PVT) in patients with cirrhosis., Methods: In this pilot study, cirrhotic (with liver function score of Child-Pugh A) patients diagnosed with PVT who were not on anticoagulant therapy received 2 weeks of subcutaneous injections of LMWH-Ca. They were then randomized to either warfarin (a full course of oral warfarin for 6 months) or rivaroxaban (a full course of oral rivaroxaban for 2 months), with 30 cases in each group. After a treatment period of up to 6 months, a comparative analysis was performed to assess the efficacy and safety of both groups. Volumetric changes in PVT were monitored dynamically using enhanced computed tomography scans before treatment at week 2 and month 6., Results: There were no statistically significant differences in the clinical characteristics of the patients between the two groups. Rivaroxaban treatment reduced PVT median volume from 1.83 cm3 at week 2 to 0.0 cm3 at month 6 and prevented the worsening of PVT after 6 months of treatment with LMWH-Ca (P < 0.001). On the other hand, warfarin treatment increased PVT median volume from 1.95 cm3 at week 2 to 3.78 cm3 at month 6 (P = 0.002). None of the 30 patients in the rivaroxaban group had clinically significant gastrointestinal bleeding, while 2 of the 30 patients (7%) in the warfarin group had gastrointestinal bleeding (P = 0.317)., Conclusion: Rivaroxaban followed by LMWH-Ca is an effective anticoagulant treatment strategy for PVT in cirrhosis., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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