From the Research
Anticoagulation therapy for patients undergoing portal vein thrombectomy during liver transplantation should include intraoperative unfractionated heparin followed by a postoperative regimen of low molecular weight heparin (LMWH) such as enoxaparin 40-60 mg twice daily, transitioning to oral anticoagulants like warfarin with a target INR of 2-3 for 3-6 months, as recommended by the most recent consensus statement 1.
Key Considerations
- The goal of anticoagulation is to prevent thrombus extension and favor recanalization, allowing physiological anastomosis during liver transplantation and improving outcome 2.
- Low-molecular-weight heparin and vitamin K antagonist have a similar safety profile, without specific data in favor of any of them 2.
- Treatment with direct anticoagulants cannot be recommended yet because of limited experience in cirrhosis 2.
- Transjugular intrahepatic portosystemic shunt could be an alternative particularly if thrombosis progresses despite satisfactory anticoagulation and/or when PVT is associated with severe portal hypertension complications 2.
Anticoagulation Regimen
- Intraoperative unfractionated heparin
- Postoperative low molecular weight heparin (LMWH) such as enoxaparin 40-60 mg twice daily
- Transition to oral anticoagulants like warfarin with a target INR of 2-3 for 3-6 months
- Consideration of direct oral anticoagulants (DOACs) like rivaroxaban or apixaban as alternatives to warfarin in select patients with normal graft function 1