Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency

Abstract

BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension. TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s. Although TIPS has good therapeutic effects on the formation of PVT, the effect of PVT on TIPS stenting has rarely been reported. Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT, which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIMTo investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODSFour hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis. Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197). The incidence of PVT before TIPS was compared between the two groups. After TIPS placement, primary patency rate was compared using Kaplan–Meier analysis at 3, 6, 9 and 12 mo, and 2 and 3 years. The clinical outcomes were analyzed.RESULTSBefore TIPS procedure, the incidence of PVT in group A was lower than in group B (P = 0.003), and TIPS technical success rate in group A was higher than in group B (P = 0.016). The primary patency rate in group A tended to be higher than in group B at 3, 6, 9 and 12 mo, 2 years and 3 years (P = 0.006, P = 0.011, P = 0.023, P = 0.032, P = 0.037 and P = 0.028, respectively). Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001), 6 mo (P = 0.003 and P = 0.005), 9 mo (P = 0.005 and P = 0.012), 12 mo (P = 0.008 and P = 0.024), 2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017), respectively. During 3-years follow-up, the 1-, 2- and 3-year survival rate in group A were higher than in group B (P = 0.008, P = 0.021, P = 0.018, respectively), but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSIONPatients with prior splenectomy have a high incidence of PVT, which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.

Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts

“…PVT, a complication with a high incidence after splenectomy, is difficult to predict and can affect patient prognosis [ 23 ]. In this study, the overall incidence of PVT was 27.6%, which was close to that found in the reference literature [ 11 , 24 ]. Our study demonstrated that DSV, DPV, BMI, and platelet count may be related to the formation of PVT after splenectomy, which is consistent with previous research results [ 23 , 25 , 26 ].…”

A Nomogram to Predict the Risk of Stent Dysfunction After TIPS in Patients with Hepatitis B Cirrhosis

“…Qi et al found that patients who underwent splenectomy had a significantly higher rate of shunt dysfunction after TIPS placement (22,23). Furthermore, Yang et al and Dong et al reported that patients with splenectomy had a high incidence of portal vein thrombosis, which can markedly affect TIPS stent patency (14,24). These results are consistent with the findings of our study.…”

Efficacy and safety of fibrinogen concentrate for on‐demand treatment of bleeding and surgical prophylaxis in paediatric patients with congenital fibrinogen deficiency

“…Treatment with HFC in this paediatric population showed a favourable safety profile; of the 10 AEs reported in this study, only two were assessed as possibly related to HFC; pyrexia and a case of PVT, which was classified as an SAE and led to discontinuation of the patient from the study. PVT is a regular complication of splenectomy, and other studies with and without HFC treatment have also reported thromboembolic events 11,17,24,25 . Patients with CFD have been documented to experience thromboembolic events in the absence of treatment with HFC 25 .…”

“…PVT is a regular complication of splenectomy, and other studies with and without HFC treatment have also reported thromboembolic events. 11,17,24,25 PK parameters were determined from the actual values for fibrinogen activity measured pre-and post-infusion. Comparable data were also obtained for PK parameters determined by fibrinogen antigen for the full PK population (data not shown).…”