Cause of portal or hepatic venous thrombosis in adults: The role of multiple concurrent factors

Abstract

According to a recent hypothesis, venous thrombosis results from the concurrence of several factors. This hypothesis was assessed in patients with portal or hepatic venous thrombosis by simultaneously investigating most of the currently identified prothrombotic disorders, local precipitating factors, and other risk factors such as oral contraceptive use. Patients with a tumorous obstruction and patients with cirrhosis with portal vein thrombosis were excluded. The prothrombotic disorders that were investigated included classical and occult myeloproliferative disorders; antiphospholipid syndrome; protein C; protein S and antithrombin deficiency; factor V Leiden; factor II; and methylene-tetrahydrofolate-reductase gene mutations. We found 1 or several prothrombotic disorders and a local precipitating factor in 26 and 10 of the 36 patients with portal vein thrombosis, respectively; and in 28 and none of the 32 patients with hepatic vein thrombosis, respectively. We found a combination of prothrombotic disorders in 5 and 9 patients with portal and hepatic vein thrombosis, respectively, whereas such a combination is expected in less than 1% of asymptomatic subjects. Of the 10 patients with a local precipitating factor, 8 had a prothrombotic disorder. Of the 13 patients who use oral contraceptives, 10 had a prothrombotic disorder. We conclude that portal or hepatic venous thrombosis should be regarded as an index for 1 or several prothrombotic disorders, whether or not local precipitating factors or oral contraceptive use are found. Concurrence of prothrombotic disorders is more common than expected.

Abdominal venous thrombosis in neonates and infants: role of prothrombotic risk factors – a multicentre case–control study

“…On the one hand, the results presented here are in contrast with data published by Seixas et al (1997) and UttenreutherFischer et al (1997) for children with PVT, neither identifying the factor V G1691A as a common risk factor in their cohorts. On the other hand, our data are in accord with very recently published adult series of cases with portal vascular occlusion demonstrating that prothrombotic disorders, especially defects within the protein C pathway, contributed to this rare thrombotic manifestation in the patients investigated (Denninger et al, 2000;Egesel et al, 2000). Thus, we suggest that this difference in the aetiology of childhood PVT with respect to genetic prothrombotic risk factors is mainly as a result of the system of patient recruitment, different childhood age populations, and the inclusion or exclusion of catheter-related thrombosis that, in two prospective studies, has been shown not to be commonly associated with a risk of PVT in sick neonates (Schwartz et al, 1997;Guimaraes et al, 1998).…”

Portal Vein Thrombosis

“…The overall mortality in chronic onset PVT is less than 10% 8,113 whereas in cirrhosis and malignancy, it is 26%. 17 A multivariate analysis done on determinants of survival in extra hepatic portal vein thrombosis showed that advanced age, malignancy, cirrhosis, mesenteric vein thrombosis, absence of abdominal inflammation, serum levels of aminotransferase and albumin are associated with reduced survival and not to complications of portal hypertension.…”

“…In upto 80% cases the underlying cause is identified when rigorously searched for. [8][9][10][11][12][13] In some cases multiple prothrombotic factors may be associated in the development of PVT. [14][15][16] In one study one or more risk factors namely prothrombotic state or abdominal inflammation was present in 87% of patients.…”

“…38 Other conditions that are associated with PVT are use of oral contraceptives, cytomegalovirus infection, 39 pregnancy, chronic inflammatory diseases and malignancies in the background of the above prothrombotic causes. 8 …”

“…Once the diagnosis of PVT is made, extensive investigation of prothrombotic disorders and local factors is recommended 8,15,109 especially for patients with a life expectancy of more than 3-6 months and where anticoagulation is considered relevant. A list of procoagulant work up is given in Table 2.…”