Direct oral anticoagulants in portal vein thrombosis in patients with cirrhosis: a systematic review and meta-analysis.

We conducted a systematic reviewand meta-analysisof studies evaluating DOAC therapy in patients with cirrhosis with PVT.

我们对评估肝硬化患者PVT中DOAC治疗的研究进行了系统评价和荟萃分析。

Random-effects models were used to estimate pooled risk ratios (RRs).

使用随机效应模型来估计合并的风险比（RRs）。

A total of 21 studies including 21 506 patients with cirrhosis with PVT were analyzed.

共分析了21项研究，包括21,506名患有肝硬化和门静脉血栓（PVT）的患者。

Among them, 2099 patients were treated with DOACs.

在这些患者中，有2099名患者接受了直接口服抗凝药（DOACs）治疗。

Compared with VKAs, DOAC therapy was associated with higher rates of complete PVT recanalization (RR, 3.49; 95% confidence interval[CI], 2.06-5.93) and lower risk of PVT progression (RR, 0.19; 95% CI, 0.04-0.78), with no significant difference in major bleeding (RR, 1.09; 95% CI, 0.79-1.51).

与维生素K拮抗剂（VKAs）相比，直接口服抗凝药（DOACs）治疗与更高的完全性门静脉血栓（PVT）再通率（相对风险，RR，3.49；95%置信区间[CI]，2.06-5.93）和较低的PVT进展风险（RR，0.19；95% CI，0.04-0.78）相关，但在主要出血事件上没有显著差异（RR，1.09；95% CI，0.79-1.51）。

DOACs were also associated with a lower risk of intracranial hemorrhage (ICH; RR, 0.49; 95% CI, 0.30-0.80).

DOACs还与较低的颅内出血（ICH; RR, 0.49; 95% CI, 0.30-0.80）风险相关。

Compared with no anticoagulation, DOAC therapy was associated with lower mortality (RR, 0.77; 95% CI, 0.71-0.84) without increased bleeding risk.

与无抗凝治疗相比，DOAC治疗与较低的死亡率（RR, 0.77; 95% CI, 0.71-0.84）相关，且没有增加出血风险。

DOAC benefit on recanalization was more pronounced in studies including only patients with Child-Pugh class A or B, whereas safety outcomes remained consistent across cirrhosis severity strata.

在仅包括 Child-Pugh A 级或 B 级患者的研巧中，直接口服抗凝药（DOAC）对再通的益处更为明显，而安全结果在肝硬化严重程度的各个层次中保持一致。

In patients with cirrhosis with PVT, DOAC therapy is associated with improved complete recanalization and reduced PVT progression compared with VKAs, without increased bleeding risk and with lower risk of ICH.

在肝硬化伴有门静脉血栓（PVT）的患者中，与维生素K拮抗剂（VKAs）相比，直接口服抗凝药（DOAC）治疗与改善完全再通和减少PVT进展相关，且没有增加出血风险，并且降低了颅内出血（ICH）的风险。

These findings support the use of DOACs in select patients, although randomized trials are needed to confirm these results.

这些发现支持在特定患者中使用直接口服抗凝药（DOACs），尽管需要随机试验来确认这些结果。