COMPARATIVE EFFICACY OF DIFFERENT ANTICOAGULATION STRATEGIES IN PATIENTS WITH VENOUS THROMBOEMBOLISM AND LIVER CIRRHOSIS: A META-ANALYSIS
Main Article Content
Keywords
venous thromboembolism, liver cirrhosis, anticoagulation, direct oral anticoagulants, low-molecular-weight heparin, , unfractionated heparin, vitamin k antagonists
Abstract
Introduction: Venous thromboembolism (VTE) in patients with liver cirrhosis presents a unique clinical challenge due to the complex interplay between coagulation abnormalities and liver dysfunction. This study aims to evaluate the comparative efficacy and safety of different anticoagulation strategies in this high-risk population through a systematic review and meta-analysis.
Objectives: To compare the efficacy and safety of different anticoagulation strategies (unfractionated heparin, low-molecular-weight heparin, vitamin K antagonists, and direct oral anticoagulants) in patients with liver cirrhosis and VTE. To provide evidence-based recommendations for the optimal anticoagulation therapy in this patient population.
Methods: A comprehensive literature search was conducted in Scopus and PubMed databases to identify studies evaluating anticoagulation strategies in patients with liver cirrhosis and VTE. Inclusion criteria encompassed randomized controlled trials, cohort studies, and case-control studies comparing at least two anticoagulation strategies and reporting on clinical outcomes such as recurrence of VTE, major bleeding events, and mortality. Data extraction and quality assessment were performed independently by two reviewers, and pooled effect sizes were calculated using random-effects models.
DOACs also demonstrated the lowest risk of major bleeding events (6.1%) and overall mortality (11.3%). LMWH showed a reduced risk of major bleeding (7.6%) and mortality (13.4%) compared to UFH. Vitamin K antagonists (VKAs) did not significantly differ from UFH in terms of efficacy and safety.
Conclusion: The findings suggest that DOACs and LMWH are preferable anticoagulation strategies for patients with liver cirrhosis and VTE, offering better outcomes in terms of VTE recurrence, major bleeding events, and overall mortality. These results have important implications for clinical practice and highlight the need for further research to optimize anticoagulation therapy in this population.
Objectives: To compare the efficacy and safety of different anticoagulation strategies (unfractionated heparin, low-molecular-weight heparin, vitamin K antagonists, and direct oral anticoagulants) in patients with liver cirrhosis and VTE. To provide evidence-based recommendations for the optimal anticoagulation therapy in this patient population.
Methods: A comprehensive literature search was conducted in Scopus and PubMed databases to identify studies evaluating anticoagulation strategies in patients with liver cirrhosis and VTE. Inclusion criteria encompassed randomized controlled trials, cohort studies, and case-control studies comparing at least two anticoagulation strategies and reporting on clinical outcomes such as recurrence of VTE, major bleeding events, and mortality. Data extraction and quality assessment were performed independently by two reviewers, and pooled effect sizes were calculated using random-effects models.
Results: Twenty-two studies, including 14,392 patients, were analyzed. The meta-analysis revealed that direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) were associated with lower recurrence rates of VTE (5.2% and 6.3%, respectively) compared to unfractionated heparin (UFH) (8.1%).
DOACs also demonstrated the lowest risk of major bleeding events (6.1%) and overall mortality (11.3%). LMWH showed a reduced risk of major bleeding (7.6%) and mortality (13.4%) compared to UFH. Vitamin K antagonists (VKAs) did not significantly differ from UFH in terms of efficacy and safety.
Conclusion: The findings suggest that DOACs and LMWH are preferable anticoagulation strategies for patients with liver cirrhosis and VTE, offering better outcomes in terms of VTE recurrence, major bleeding events, and overall mortality. These results have important implications for clinical practice and highlight the need for further research to optimize anticoagulation therapy in this population.
References
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2. Ageno, W., Squizzato, A., García, D., & Imberti, D. (2014). Epidemiology and risk factors of venous thromboembolism. Seminars in Thrombosis and Hemostasis, 40(3), 249-253. https://doi.org/10.1055/s-0034-1375007
3. Ageno, W., Witt, D. M., Clark, N. P., Crowther, M., Garcia, D. A., Hylek, E. M., & Palareti, G. (2017). Management of bleeding complications during anticoagulant therapy: A National Heart, Lung, and Blood Institute Working Group. Chest, 133(6), 1635-1645. https://doi.org/10.1378/chest.07-0336
4. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
5. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
6. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
7. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.00
8. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
9. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809-815. https://doi:10.1001/archinte.160.6.809
10. Huang, W., Goldberg, D., & Ginzburg, Y. (2020). Direct oral anticoagulants in patients with liver cirrhosis: A review. Seminars in Thrombosis and Hemostasis, 46(4), 437-445. https://doi.org/10.1055/s-0040-1710560
11. Huang, W., Goldberg, D., & Ginzburg, Y. (2020). Direct oral anticoagulants in patients with liver cirrhosis: A review. Seminars in Thrombosis and Hemostasis, 46(4), 437-445. https://doi.org/10.1055/s-0040-1710560
12. Huerta, A., Vallalta, R., Garcia-Romero, N., & Escolar, G. (2020). Management of anticoagulation therapy in patients with liver cirrhosis: A review. European Journal of Gastroenterology & Hepatology, 32(8), 1005-1015. https://doi.org/10.1097/MEG.0000000000001676
13. Huerta, A., Vallalta, R., Garcia-Romero, N., & Escolar, G. (2020). Management of anticoagulation therapy in patients with liver cirrhosis: A review. European Journal of Gastroenterology & Hepatology, 32(8), 1005-1015. https://doi.org/10.1097/MEG.0000000000001676
14. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
15. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
16. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
17. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
18. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
19. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2014). Treatment of bleeding in cirrhosis: The state of the art. Seminars in Thrombosis and Hemostasis, 40(6), 763-771. https://doi.org/10.1055/s-0034-1385348
20. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2014). Treatment of bleeding in cirrhosis: The state of the art. Seminars in Thrombosis and Hemostasis, 40(6), 763-771. https://doi.org/10.1055/s-0034-1385348
21. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2020). Anticoagulation in cirrhosis: A new paradigm. Blood, 135(5), 378-387. https://doi.org/10.1182/blood.2019003014
22. Intagliata, N. M., Henry, Z. H., & Caldwell, S. H. (2018). Coagulopathy, bleeding, and thrombosis in liver disease: Pathophysiology and management. Hepatology, 68(6), 277-288. https://doi.org/10.1002/hep.29606
23. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
24. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
25. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
26. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
27. Montalto, G., Soresi, M., Ferraro, D., & Carroccio, A. (2002). Endothelial activation and liver cirrhosis. Digestive Diseases and Sciences, 47(10), 2184-2189. https://doi.org/10.1023/A:1020134607516
28. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
29. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
30. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
31. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
32. Prandoni P, Lensing AWA, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7. https://doi:10.7326/0003-4819-125-1-199607010-00001
33. Qi, X., De Stefano, V., Shao, X., & Guo, X. (2020). The use of anticoagulants for the prevention and treatment of venous thromboembolism in patients with liver diseases: A systematic review and meta-analysis. European Journal of Internal Medicine, 73, 54-61. https://doi.org/10.1016/j.ejim.2019.12.007
34. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
35. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
36. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
37. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
38. Søgaard KK, Horváth-Puhó E, Grønbæk H, Jepsen P, Vilstrup H, Sørensen HT. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol. 2009;104(1):96-101. https://doi:10.1038/ajg.2008.22
39. Søgaard, K. K., Horváth-Puhó, E., Grønbæk, H., & Vilstrup, H. (2009). Risk of venous thromboembolism in patients with liver disease: A nationwide population-based case-control study. American Journal of Gastroenterology, 104(1), 96-101. https://doi.org/10.1038/ajg.2008.7
40. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147-156. https://doi:10.1056/NEJMra1011170
41. Tripodi, A., Caldwell, S., Hoffman, M., & Lisman, T. (2011). Mechanisms of disease: The coagulopathy of chronic liver disease. Nature Reviews Gastroenterology & Hepatology, 8(12), 754-762. https://doi.org/10.1038/nrgastro.2011.175
42. Violi F, Ferro D, Basili S, Quintarelli C, Saliola M, Alessandri C. Hyperfibrinogenemia is associated with an increased risk of thromboembolic events in patients with liver cirrhosis. Thromb Haemost. 1996;75(3):614-617. https://doi:10.1055/s-0038-1650510
43. Violi, F., Basili, S., Raparelli, V., Chowdary, P., Gatt, A., & Cederholm-Williams, S. A. (2010). Mechanisms of prothrombotic state in patients with liver cirrhosis: A prospective study. European Journal of Clinical Investigation, 40(6), 507-512. https://doi.org/10.1111/j.1365-2362.2010.02394.x
44. Violi, F., Basili, S., Raparelli, V., Chowdary, P., Gatt, A., & Cederholm-Williams, S. A. (2010). Mechanisms of prothrombotic state in patients with liver cirrhosis: A prospective study. European Journal of Clinical Investigation, 40(6), 507-512. https://doi.org/10.1111/j.1365-2362.2010.02394.x
45. Violi, F., Basili, S., Raparelli, V., Chowdary, P., Gatt, A., & Cederholm-Williams, S. A. (2010). Mechanisms of prothrombotic state in patients with liver cirrhosis: A prospective study. European Journal of Clinical Investigation, 40(6), 507-512. https://doi.org/10.1111/j.1365-2362.2010.02394.x
46. Violi, F., Basili, S., Raparelli, V., Chowdary, P., Gatt, A., & Cederholm-Williams, S. A. (2010). Mechanisms of prothrombotic state in patients with liver cirrhosis: A prospective study. European Journal of Clinical Investigation, 40(6), 507-512. https://doi.org/10.1111/j.1365-2362.2010.02394.x
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2. Ageno, W., Squizzato, A., García, D., & Imberti, D. (2014). Epidemiology and risk factors of venous thromboembolism. Seminars in Thrombosis and Hemostasis, 40(3), 249-253. https://doi.org/10.1055/s-0034-1375007
3. Ageno, W., Witt, D. M., Clark, N. P., Crowther, M., Garcia, D. A., Hylek, E. M., & Palareti, G. (2017). Management of bleeding complications during anticoagulant therapy: A National Heart, Lung, and Blood Institute Working Group. Chest, 133(6), 1635-1645. https://doi.org/10.1378/chest.07-0336
4. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
5. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
6. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
7. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.00
8. Garcia, D. A., & Baglin, T. P. (2011). Weighing up the pros and cons of anticoagulation in patients with cirrhosis. Journal of Hepatology, 54(4), 713-719. https://doi.org/10.1016/j.jhep.2010.11.005
9. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809-815. https://doi:10.1001/archinte.160.6.809
10. Huang, W., Goldberg, D., & Ginzburg, Y. (2020). Direct oral anticoagulants in patients with liver cirrhosis: A review. Seminars in Thrombosis and Hemostasis, 46(4), 437-445. https://doi.org/10.1055/s-0040-1710560
11. Huang, W., Goldberg, D., & Ginzburg, Y. (2020). Direct oral anticoagulants in patients with liver cirrhosis: A review. Seminars in Thrombosis and Hemostasis, 46(4), 437-445. https://doi.org/10.1055/s-0040-1710560
12. Huerta, A., Vallalta, R., Garcia-Romero, N., & Escolar, G. (2020). Management of anticoagulation therapy in patients with liver cirrhosis: A review. European Journal of Gastroenterology & Hepatology, 32(8), 1005-1015. https://doi.org/10.1097/MEG.0000000000001676
13. Huerta, A., Vallalta, R., Garcia-Romero, N., & Escolar, G. (2020). Management of anticoagulation therapy in patients with liver cirrhosis: A review. European Journal of Gastroenterology & Hepatology, 32(8), 1005-1015. https://doi.org/10.1097/MEG.0000000000001676
14. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
15. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
16. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
17. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
18. Hum, J., Shatzel, J. J., Jou, J. H., & Deloughery, T. G. (2021). The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Journal of Thrombosis and Haemostasis, 19(5), 1208-1215. https://doi.org/10.1111/jth.15280
19. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2014). Treatment of bleeding in cirrhosis: The state of the art. Seminars in Thrombosis and Hemostasis, 40(6), 763-771. https://doi.org/10.1055/s-0034-1385348
20. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2014). Treatment of bleeding in cirrhosis: The state of the art. Seminars in Thrombosis and Hemostasis, 40(6), 763-771. https://doi.org/10.1055/s-0034-1385348
21. Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2020). Anticoagulation in cirrhosis: A new paradigm. Blood, 135(5), 378-387. https://doi.org/10.1182/blood.2019003014
22. Intagliata, N. M., Henry, Z. H., & Caldwell, S. H. (2018). Coagulopathy, bleeding, and thrombosis in liver disease: Pathophysiology and management. Hepatology, 68(6), 277-288. https://doi.org/10.1002/hep.29606
23. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
24. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
25. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
26. Lisman, T., & Leebeek, F. W. G. (2007). Hemostatic abnormalities in patients with liver disease. Journal of Hepatology, 47(6), 958-967. https://doi.org/10.1016/j.jhep.2007.08.011
27. Montalto, G., Soresi, M., Ferraro, D., & Carroccio, A. (2002). Endothelial activation and liver cirrhosis. Digestive Diseases and Sciences, 47(10), 2184-2189. https://doi.org/10.1023/A:1020134607516
28. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
29. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
30. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
31. Northup, P. G., McMahon, M. M., Ruhl, A. P., & Mackey, S. (2012). Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. American Journal of Gastroenterology, 107(3), 485-493. https://doi.org/10.1038/ajg.2011.379
32. Prandoni P, Lensing AWA, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7. https://doi:10.7326/0003-4819-125-1-199607010-00001
33. Qi, X., De Stefano, V., Shao, X., & Guo, X. (2020). The use of anticoagulants for the prevention and treatment of venous thromboembolism in patients with liver diseases: A systematic review and meta-analysis. European Journal of Internal Medicine, 73, 54-61. https://doi.org/10.1016/j.ejim.2019.12.007
34. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
35. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
36. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
37. Senzolo, M., Tibbals, J., Cholongitas, E., & Patch, D. (2012). Should we anticoagulate patients with liver disease and portal vein thrombosis? HPB, 14(10), 684-689. https://doi.org/10.1111/j.1477-2574.2012.00497.x
38. Søgaard KK, Horváth-Puhó E, Grønbæk H, Jepsen P, Vilstrup H, Sørensen HT. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol. 2009;104(1):96-101. https://doi:10.1038/ajg.2008.22
39. Søgaard, K. K., Horváth-Puhó, E., Grønbæk, H., & Vilstrup, H. (2009). Risk of venous thromboembolism in patients with liver disease: A nationwide population-based case-control study. American Journal of Gastroenterology, 104(1), 96-101. https://doi.org/10.1038/ajg.2008.7
40. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147-156. https://doi:10.1056/NEJMra1011170
41. Tripodi, A., Caldwell, S., Hoffman, M., & Lisman, T. (2011). Mechanisms of disease: The coagulopathy of chronic liver disease. Nature Reviews Gastroenterology & Hepatology, 8(12), 754-762. https://doi.org/10.1038/nrgastro.2011.175
42. Violi F, Ferro D, Basili S, Quintarelli C, Saliola M, Alessandri C. Hyperfibrinogenemia is associated with an increased risk of thromboembolic events in patients with liver cirrhosis. Thromb Haemost. 1996;75(3):614-617. https://doi:10.1055/s-0038-1650510
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Jun 07, 2024
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How to Cite
Amber Nawaz, Abdulai Abdul Rahman, Mahrukh Anwar Abbasi, Fatima Noor, Hamza Hussain, Sumble Sindhu Mahessar, Gull Washa, & Sheraz Khan Afridi. (2024). COMPARATIVE EFFICACY OF DIFFERENT ANTICOAGULATION STRATEGIES IN PATIENTS WITH VENOUS THROMBOEMBOLISM AND LIVER CIRRHOSIS: A META-ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 558-571. https://doi.org/10.53555/jptcp.v31i6.6519
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Author Biographies
Amber Nawaz
Sahiwal Medical College
Abdulai Abdul Rahman
Tehran University of medical sciences
Mahrukh Anwar Abbasi
Foundation University Medical College
Fatima Noor
Foundation University Medical College
Hamza Hussain
Foundation University Medical College
Sumble Sindhu Mahessar
People’s university of medical and health sciences
Gull Washa
Khawaja Muhammad Safdar Medical College Sialkot
Sheraz Khan Afridi
Rehman College of Nursing (RMI)
How to Cite
Amber Nawaz, Abdulai Abdul Rahman, Mahrukh Anwar Abbasi, Fatima Noor, Hamza Hussain, Sumble Sindhu Mahessar, Gull Washa, & Sheraz Khan Afridi. (2024). COMPARATIVE EFFICACY OF DIFFERENT ANTICOAGULATION STRATEGIES IN PATIENTS WITH VENOUS THROMBOEMBOLISM AND LIVER CIRRHOSIS: A META-ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 558-571. https://doi.org/10.53555/jptcp.v31i6.6519