Thrombosis of the Portal Venous System in Cirrhotic vs. Non-Cirrhotic Patients

Cruz-Ramón, Vania; Chinchilla-López, Paulina; Ramírez-Pérez, Oscar; Aguilar-Olivos, Nancy E.; Alva-López, Luis Felipe; Fajardo-Ordoñez, Ericka; Ponciano-Rodríguez, Guadalupe; Intagliata, Nicolas M.; Caldwell, Stephen H.; Qi, Xingshun; Méndez-Sánchez, Nahúm

doi:10.5604/01.3001.0011.7392

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…The association between PVT and alcoholic etiology was recently confirmed by Scheiner et al[ 21 ]. Cruz et al[ 22 ] demonstrated that non-alcoholic steato-hepatitis was more frequently associated with PVT (40.48%), followed by hepatitis C virus (23.81%) and autoimmune hepatitis (19.05%), all of these etiologies being characterized by a significant pro-inflammatory status. By contrast, in another study with 199 candidates for LT, no relation was found between the etiology of liver disease and PVT prevalence[ 23 ].…”

Section: Prevalence and Predictors For Non-malignant Pvt: Etiology Ofmentioning

confidence: 99%

Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

Gîrleanu

Trifan

Stanciu

et al. 2018

WJG

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Portal vein thrombosis (PVT) is a frequent and serious complication in patients with liver cirrhosis (LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease (compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex end-points such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.

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Section: Prevalence and Predictors For Non-malignant Pvt: Etiology Ofmentioning

confidence: 99%

Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

Gîrleanu

Trifan

Stanciu

et al. 2018

WJG

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“…PVT is mostly seen in liver cirrhosis, with a prevalence ranging from 10% to 23%[ 6 ]. Non-cirrhotic PVT rarely occurs, with a prevalence of approximately 1%, and has an intimate relationship with inherited or acquired coagulation diseases, such as primary myeloproliferative disorders, Protein C/S deficiency, and abdominal surgery[ 7 ]. In addition to the etiology of PVT, it is particularly important to distinguish acute PVT from chronic PVT as the treatment is different.…”

Section: Discussionmentioning

confidence: 99%

Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

Wang

Wei

Niu

et al. 2018

WJG

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AIMTo evaluate the safety and efficacy of agitation thrombolysis (AT) combined with catheter-directed thrombolysis (CDT) for the treatment of non-cirrhotic acute portal vein thrombosis (PVT).METHODSNine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at 1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.RESULTSAT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre- and post-treatment (P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.CONCLUSIONAT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.

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“…Studies investigating PVT in noncirrhotic patients were excluded, as risk factors, epidemiology, and treatment approach of PVT are distinct in patients with and without cirrhosis. 23 Search results were reviewed for duplicate entries, and studies from the same institution were reviewed for time of subject enrollment to ensure no patient population was duplicated.…”

Section: Methodsmentioning

confidence: 99%

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

Davis

Ogurick

Rothermel

et al. 2019

Clin Appl Thromb Hemost

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Portal vein thromboses (PVTs) are associated with hepatic decompensation, worse survival, and worse liver transplant outcomes. We evaluated the impact of anticoagulation (AC) and transjugular intrahepatic portosystemic shunting (TIPS) on recanalization and mortality in patients with cirrhosis and PVT. Systematic search of electronic databases was performed. Clinical trials and observational studies that evaluated primary outcomes of recanalization and survival in patients with cirrhosis having PVT treated with AC or TIPS were included. Risk of bias was assessed. Summary odds ratios (ORs) for pooled data from the included studies were generated using a random effects model. A total of 505 studies were screened for inclusion. After review, 7 studies were ultimately included. Data from 327 patients in total were evaluated. Overall, treatment with either AC or TIPS resulted in partial or complete recanalization (OR: 4.56 [95% confidence interval, CI: 2.46-8.47]) but did not significantly impact mortality (OR: 0.57 [95% CI: 0.21-1.57]). The summary OR of AC for recanalization was 6.00 (95% CI: 2.38-15.07). The summary OR of TIPS for recanalization was 3.80 (95% CI: 1.47-9.83). The summary OR of mortality in patients treated with AC for PVT was 0.28 (95% CI: 0.08-0.95). The mortality summary OR was 1.10 (95% CI 0.23-5.16) in patients who underwent TIPS. There was insufficient data to assess complications such as hepatic encephalopathy or bleeding. Both AC and TIPS have a significant effect on recanalization. Anticoagulation appears to have a protective effect on mortality that is not seen with TIPS. More studies with control groups are need.

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Thrombosis of the Portal Venous System in Cirrhotic vs. Non-Cirrhotic Patients

Cited by 19 publications

References 25 publications

Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

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