Enoxaparin prevents PVT in advanced cirrhosis

Enoxaparin significantly reduces portal vein thrombosis (PVT) and increases overall survival in patients with advanced cirrhosis, the results of an Italian study show.

The authors also found additional benefits beyond the drug's established effect on PVT.

"Enoxaparin treatment was associated with a definite improvement of liver function and striking decreases of occurrence or reccurence of decompensation," say Erica Villa (University of Modena and Reggio Emilia, Italy) and colleagues.

The study included 70 cirrhosis patients with a Child-Pugh score of 7-10, aged 18-75 years who received enoxaparin 4000 IU/day for 48 weeks or no treatment. Patients were followed up for a mean of 58 weeks in the control group and 89 weeks in the enoxaparin group, with ultrasound evaluation of the portal vein system every 3 months.

As reported in Gastroenterology, patients receiving enoxaparin were 90% less likely to experience PVT than those who did not. Overall, 8.8% of enoxaparin-treated patients developed PVT compared with 27.7% in the control group, and no cases developed in the enoxaparin group within the first 2 years.

While decompensation occurred at an equal rate in both groups during the follow-up period, significantly fewer patients experienced progression during active treatment (11.7 vs 59.4%).

Furthermore, receiving enoxaparin was also an independent predictor of survival, decreasing the mortality risk by 64% compared with no treatment.

Although an established treatment for PVT in cirrhosis patients, enoxaparin has not previously been tested for prophylaxis of PVT in this group.

The authors suggest that enoxaparin exerts its additional effects on decompensation by improving intestinal microcirculation. This may help protect against damage to the intestinal mucosal barrier in advanced cirrhosis, which is known to increase the risk for clotting.

Noting that further research is needed to confirm its mechanism of action, they suggest that in future larger, double-blind randomized trials of enoxaparin with longer follow up should be conducted.

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