Portal Vein Thrombosis after Partial Splenic Embolization in Liver Cirrhosis: Efficacy of Anticoagulation and Long-term Follow-up

Cai, Mingyue; Zhu, Kangshun; Huang, Wensou; Meng, Xiangjun; He, Ke-Ke; Zhou, Bin; Guo, Yongjian; Song, Hong

doi:10.1016/j.jvir.2013.08.018

Cited by 36 publications

(22 citation statements)

References 21 publications

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“…One patient developed a single hematemesis episode with no serious consequences. Major complications after PSE usually arise from a large area of spleen embolization and are not necessarily associated with a more efficient result . In our study, most of the patients had a 50–70% infarction area with no major complications.…”

Section: Discussionmentioning

confidence: 49%

Partial splenic embolization to permit continuation of systemic chemotherapy

Luz

Marchiori

et al. 2016

Cancer Medicine

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Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure‐related morbidity.

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Section: Discussionmentioning

confidence: 49%

Partial splenic embolization to permit continuation of systemic chemotherapy

Luz

Marchiori

et al. 2016

Cancer Medicine

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“…Treatment appears to improve PVT with and without thrombophilia (83). Few bleeding complications have been reported following PVT treatment with either VKA or LMWH (84,85). Similar findings were reported in a single center study of VKA thrombosis prophylaxis in liver transplant recipients (86).…”

Section: Clinical Outcomessupporting

confidence: 54%

Thrombotic Complications in Cirrhotic Patients: Balancing Risks and Benefits of Anticoagulation Treatment

Scărlătescu¹,

Mandell²,

Tomescu³

2016

JTMR

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The risk of excessive bleeding and thrombotic complications coexist in cirrhotic patients due to synthetic reduction in both pro and anticoagulants. However, investigators suggest the prevalence and consequences of thrombotic complications are underestimated. There is convincing evidence that thrombosis causes worsening portal hypertension, hepatic fibrosis and increases patient mortality. New evidence is emerging about the benefits of treating and preventing thrombotic complications in patients with liver disease. In the absence of welldesigned trials, clinical experience has become the most consistent guide to choose and dose anticoagulant drugs in this patient population. Practical use of anticoagulants however, is hindered by the lack of simple methods to monitor drug effect. In this review, we present a concise appraisal of current evidence on the most commonly studied indications for anticoagulation in cirrhotic patients. Information about drug action, dosing and monitoring are presented to provide a basis for clinical decision-making. The ongoing challenges in identifying therapeutic targets for treatment and monitoring drug effects are examined to highlight important clinical questions that have not yet been fully addressed.

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“…Eight studies (Figure 1), including 353 patients, assessed the effect of anticoagulant therapy (low molecular-weight heparin [LWMH]/Warfarin vs no therapy) in patients with cirrhosis and PVT [10][11][12][13][14][15][16][17] ; clinical characteristics of the studies are reported in Table 1. Anticoagulant treatment consisted of LMWH or vitamin K antagonists and lasted approximately 6 months; follow-up was approximately 2 years (see Table 1).…”

Section: Resultsmentioning

confidence: 99%