SVR to DAA does not affect the risk of portal vein thrombosis in patients with advanced chronic liver disease

Background&aims Sustained virologic response (SVR) to direct-acting antivirals (DAA) ameliorates portal hypertension, improves hepatic function and may reverse the procoagulant imbalance observed in advanced chronic liver disease (ACLD). However, a worrisome incidence of portal vein thrombosis (PVT) immediately after antiviral therapy has recently been reported. Therefore, we analyzed the long-term impact of SVR on the development of non-tumoral PVT.

Patients&methods Our study comprised two well-characterized cohorts (‘HCV-treatment’:n = 358/‘No-HCV-treatment’:n = 179) of patients with chronic hepatitis C (CHC) and advanced ACLD who underwent standardized ultrasound surveillance. In the main analysis, the event of interest was PVT, while events hindering its observation (tumoral PVT/liver transplantation/death) or modifying the risk (transjugular intrahepatic portosystemic shunt/anticoagulation) were considered as competing risks.

Results Thirteen (3.6 %) patients in the ‘HCV-treatment’-cohort developed a PVT during a median follow-up of 36.9 months, while 10 (5.6 %) patients in the ‘No-HCV-treatment’-cohort were diagnosed with PVT during a median follow-up of 42.2 months. High pre- and post-treatment Child-Turcotte-Pugh scores were the only independent risk factors for PVT development. Importantly, HCV cure did not modify the risk of PVT in competing risk regression models adjusted for previous variceal bleeding, use of non-selective beta-blockers, as well as pre- or post-treatment Child-Turcotte-Pugh scores (‘HCV-treatment’ vs. ‘No-HCV-treatment’; adjusted subdistribution hazard ratio (aSHR): 1.41 (95 % confidence interval (95 %CI): 0.589-3.39) and aSHR: 1.44 (95 %CI: 0.588-3.54), respectively) (Figure). In contrast, SVR was associated with a substantial reduction in competing events, most importantly, adverse liver-related outcomes and death (e.g., aSHR: 0.156 (95 %CI: 0.056-0.43).

Conclusions Although HCV cure reduces the risk of mortality it does not reduce the risk of PVT in patients who have pre-treatment ACLD. Accordingly, ACLD patients achieving SVR remain at risk for PVT, and thus, should be carefully monitored for PVT. The risk for PVT is increased in patients with impaired hepatic function pre- or post-treatment.

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Publication History

Article published online:
26 May 2020