Experience With Dabigatran on Rate of Portal Vein Thrombosis Recanalization, Disease Progression and Survival

ABSTRACT Background and Aims We assessed clinical, procoagulant and genetic risk factors and clinical outcomes in dabigatran‐treated patients with non‐tumoural acute and acute‐on‐chronic portal vein thrombosis (PVT). Methods Patients with a new diagnosis of non‐tumoural acute and acute‐on‐chronic PVT between January 2021 and January 2024 (aged ≥ 18 years) in those without/with cirrhosis (Child‐Pugh (CP)‐A/B/C ≤ 10) were started on dabigatran and followed and compared with those on vitamin K antagonist (VKA) and untreated individuals. Results Dabigatran was prescribed in 119 patients with PVT type 1 (61, 51.3%), type 2 (34, 28.6%), type 3 (24, 20.2%); 72 (60.5%) with cirrhosis [CP‐A (27, 37.5%), CP‐B (43, 59.7%) and CP‐C10 (2, 2.8%)]. Procoagulant factors noted were JAK2V617F (10.1%), CALR (2.5%) and factor V Leiden (1.6%) mutations, antiphospholipid syndrome (APS, 15.2%), isolated Protein C (14.3%) and Protein S (16.8%) deficiency. Comparators: 28 patients who declined anticoagulation/were unable to come for follow‐up, and six with CP‐C received VKA. Overall recanalization rate (RR) on dabigatran was 56 (47.1%); 25 (21%) complete recanalization, 31 (26%) partial recanalization and 63 (52.9%) stable PVT over median follow‐up of 32 months. Patients not anticoagulated had a spontaneous RR in 21.4% (28 patients; p = 0.005 compared with dabigatran group) and none recanalized on VKA. On multivariable analysis, predictors of recanalization on dabigatran were Factor VIII Antigen level (FVIII:Ag, HR 0.6; 95% CI 0.3–0.9, p = 0.032), non‐occlusive PVT (HR 3.5, 95% CI 1.9–5.6, p = 0.025) and acute PVT (HR 2.1; 95% CI 1.5–3.2, p = 0.003). Mortality was 14 (11.8%). Conclusion On dabigatran, 47% of 119 patients achieved portal vein recanalization over 32 months of follow‐up which was higher than the spontaneous RR (21.4%) in an untreated cohort. High Factor VIII:Ag was a predictor of non‐recanalization. Dabigatran was safe in cirrhosis (CP‐A and B) while further work is needed in CP‐C.