EFFICACY AND SAFETY OF RIVOROXABAN IN PATIENT WITH PORTAL VEIN THROMBOSIS IN THE SETTING OF DECOMPENSATED CIRRHOSIS

Abstract

Background: Portal vein thrombosis (PVT) is a severe complication in decompensated cirrhosis, exacerbating portal hypertension and increasing morbidity. Effective anticoagulation is essential to promote recanalization while minimizing bleeding risks. Traditional anticoagulants, including low-molecular-weight heparin and vitamin K antagonists, require frequent monitoring and pose higher bleeding risks. Direct oral anticoagulants, such as rivaroxaban, have emerged as potential alternatives, but their safety and efficacy in cirrhotic patients remain uncertain. This study evaluates the role of rivaroxaban in achieving PVT recanalization compared to standard care.

Objective: To assess the efficacy and safety of rivaroxaban in PVT recanalization and identify clinical predictors of successful treatment in patients with decompensated cirrhosis.

Methods: A cross-sectional study was conducted over six months at Pakistan Emirates Military Hospital, Rawalpindi. A total of 150 patients with decompensated cirrhosis and PVT were enrolled and divided into a rivaroxaban group (n=75) and a control group (n=75). The control group received standard care, while the rivaroxaban group received a daily dose based on renal function and bleeding risk. Recanalization was assessed using Doppler ultrasound and contrast-enhanced imaging at three and six months. Data were analyzed using SPSS 26, with Kaplan-Meier analysis comparing recanalization rates and multivariate logistic regression identifying predictors of complete recanalization.

Results: Complete recanalization was significantly higher in the rivaroxaban group (65%) than in the control group (30%, p < 0.001). Persistent occlusion was lower in the rivaroxaban group (10% vs. 30%, p = 0.002). Multivariate analysis identified rivaroxaban use (OR: 3.30, p < 0.001), PVT duration <3 months (OR: 2.89, p = 0.001), and platelet count ≥100,000/mm³ (OR: 2.18, p = 0.006) as independent predictors of complete recanalization. No significant difference in major bleeding events was observed between groups (p = 0.317).

Conclusion: Rivaroxaban is a safe and effective treatment for PVT in decompensated cirrhosis, significantly improving recanalization rates without increasing bleeding risks. Early anticoagulation and preserved liver function enhance treatment success. Further studies are needed to confirm long-term efficacy and define optimal treatment duration.