Bayesian Network Meta-Analysis of Randomized Controlled Trials Comparing the Efficacy of Diverse Interventions in Preventing Portal Venous System Thrombosis Following Splenectomy in Patients with Liver Cirrhosis.

BACKGROUND

Patients with liver cirrhosis undergoing splenectomy exhibit a high incidence of portal venous system thrombosis (PVST). Therapeutic interventions may prevent PVST development. This Bayesian network meta-analysis systematically evaluates the efficacy and safety of diverse anticoagulation regimens for PVST prophylaxis.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we systematically searched PubMed, Cochrane Library, and other databases from their inception to March 1, 2025, for randomized controlled trials investigating interventions to prevent PVST after splenectomy in cirrhotic patients. Artificial intelligence-assisted screening was conducted using the AS Review tool. A Bayesian network meta-analysis was performed to synthesize preventive effect estimates across interventions.

RESULTS

Initial database searches identified 636 records, with 6 randomized controlled trials (557 patients) meeting inclusion criteria. Five interventions were evaluated, with the primary outcome being PVST incidence and secondary outcomes including main portal vein thrombosis and splenic vein thrombosis. Analyses demonstrated that direct oral anticoagulants, specifically apixaban, demonstrated superior efficacy in reducing PVST, main portal vein thrombosis, and splenic vein thrombosis rates at postoperative time points (7 days, 1 month, 3 months, and 6 months). However, the certainty of evidence for this conclusion was rated as low. In contrast, the evidence certainty for low-molecular-weight heparin combined with warfarin was assessed as moderate.

CONCLUSION

Current evidence indicates that for Child-Pugh class A/B cirrhosis patients undergoing splenectomy, the combination of low-molecular-weight heparin and warfarin should be considered as the first-line anticoagulation strategy for PVST. Although existing evidence remains insufficient to elevate direct oral anticoagulants, particularly apixaban, to a higher prioritization level, they demonstrate promising therapeutic potential.