Predictors and prognostic impact of spontaneous portal vein thrombosis recanalization in cirrhosis: An individual patient data meta-analysis.
Antonio Guerrero, Laura Del Campo, Angelo Luca et al.
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In 30 seconds
This individual patient data meta-analysis pooled cohort studies of patients with cirrhosis and portal vein thrombosis (PVT) who were not receiving anticoagulation. Across eight studies and 586 patients, spontaneous recanalization occurred in 264 (47.7%). Recanalization was independently associated with lower mortality (aSHR 0.51; 95% CI 0.28-0.90), with the association driven by complete recanalization. A survival benefit was also associated with recanalization of thrombosis in the main portal vein trunk, but not isolated intrahepatic branch thrombosis. The observational findings establish prognostic associations, not treatment effects.
Key findings
- Spontaneous recanalization occurred in 264 (47.7%) of 586 patients across eight cohort studies.
- Overall recanalization was associated with lower mortality (aSHR 0.51; 95% CI 0.28-0.90); complete recanalization showed aSHR 0.45; 95% CI 0.21-0.94.
- Recanalization of main portal vein trunk thrombosis was associated with a survival benefit (interaction SHR 0.39; 95% CI 0.16-0.91; p=0.02); no benefit was observed for isolated intrahepatic branch thrombosis.
- Recanalization was more likely with Child-Pugh A status, partial thrombosis, and isolated intrahepatic location.
Why it matters
The findings suggest that spontaneous PVT recanalization is common and may carry prognostic information in cirrhosis, particularly when recanalization is complete or involves the main portal vein trunk. The differing associations by thrombus location may help frame prognosis, while the observational design means the results cannot establish that inducing recanalization improves survival.
What to keep in mind
The analysis pooled cohort studies rather than randomized treatment comparisons; its findings are observational and cannot establish that recanalization causes improved survival or that anticoagulation improves outcomes.