Use of non-selective beta blockers (NSBBs) — medications used to lower pressure in the liver’s blood vessels — was associated with a more than twofold higher risk of blood clots in the main vein of the liver in patients with cirrhosis due to primary biliary cholangitis (PBC), a recent study published in Liver International found.
Portal vein thrombosis (PVT) — a blood clot that can impair blood flow through the liver — is a known complication of cirrhosis and has been linked to worse clinical outcomes. PVT affects a substantial proportion of patients with cirrhosis, with previous studies estimating a prevalence of around 14% and a lifetime incidence of about 10%. However, the impact of treatment for PBC on this risk has remained unclear.
In the study, researchers evaluated risk factors for PVT in patients with cirrhosis due to PBC, with a focus on disease-specific treatment and commonly used medications. Most patients in the PBC cohort had advanced disease, with the vast majority presenting with decompensated cirrhosis. Among 786 patients, 67 developed PVT over approximately eight years of follow-up. Use of NSBBs was associated with about a 2.5-fold higher risk.
Researchers suggested that NSBBs may increase the risk of portal vein thrombosis possibly by reducing portal blood flow velocity — a change that has been linked to clot formation — although further studies are needed to confirm this mechanism.
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In contrast, treatment with ursodeoxycholic acid (UDCA), the standard therapy for PBC, was not associated with either an increased or reduced risk of PVT. Response to treatment also did not change the likelihood of developing the condition.
Similar patterns were observed in a secondary cohort of patients with hepatitis C virus–related cirrhosis, although those results were not the primary focus of the analysis.
“Because our study design does not allow us to draw conclusions about causality, additional studies with more detailed characterization of cirrhosis stage as well as longer follow-up are needed to confirm our observations,” the authors concluded.
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