Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS Versus Anticoagulation Versus No Treatment

Abstract

Background: There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. Methods: This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6–9 months) and late follow-up (9–16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. Results: The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up (p = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up (p = 0.007). No bleeding complications attributable to anticoagulation were observed. Conclusion: TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.

Expanding Indications of TIPS in the Management of Portal Hypertension Complications

“…In a recent study by Zhan et al, TIPS improved thrombus burden in 72% of patients while only 27 and 10% of anticoagulated and untreated patients, respectively, demonstrated improvement. 27 In a recent meta-analysis by Valentin et al, the authors reported 84.4% complete and partial recanalization and 74% complete recanalization rates with TIPS. 30 Sun et al demonstrated the efficacy of TIPS in controlling the portal vein pressure and rebleeding rates in patients with chronic PVT ( Table 5 ).…”

“…25 In addition, around 36% recurrence rate has been reported after the discontinuation of anticoagulation. 27 These limitations of anticoagulation are the determinants that favor TIPS in clinical practice.…”

Portal Vein Thrombosis in the Setting of Cirrhosis: A Comprehensive Review

“…The rates of major complications were 10% [ 156 , 157 ]. When compared to anticoagulation, TIPS has a higher effectiveness in terms of portal vein recanalization [ 158 , 159 ]. Regarding portal-hypertension-related complications, two randomized controlled trials have evaluated the effectiveness of TIPS in comparison to standard therapy (endoscopic band ligation + propranolol + anticoagulation) for the prevention of variceal rebleeding in cirrhotic patients with PVT.…”

Neutrophil extracellular traps are associated with enhanced procoagulant activity in liver cirrhosis patients with portal vein thrombosis

“…PVT is a frequent and serious complication of liver cirrhosis (LC), particularly in its advanced stages. Namely, the prevalence of PVT range between 0.6% and 28% in patients with cirrhosis 2 . Remarkably, most patients are asymptomatic at the time of PVT diagnosis 3 .…”

“…Namely, the prevalence of PVT range between 0.6% and 28% in patients with cirrhosis. 2 Remarkably, most patients are asymptomatic at the time of PVT diagnosis. 3 However, the 2‐year survival rate of patients with PVT is reduced by 55% compared with patients without PVT due to hepatic dysfunction.…”