Platelet Activation Assessed by Glycoprotein VI/Platelet Ratio Is Associated With Portal Vein Thrombosis After Hepatectomy and Splenectomy in Patients With Liver Cirrhosis

Abstract

Portal vein thrombosis (PVT) is a serious complication after hepatobiliary-pancreatic surgery. Portal vein thrombosis often develops in patients with liver cirrhosis (LC) postoperatively, although they have low platelet counts. Platelet activation is one of the causes of thrombosis formation, and soluble form of glycoprotein VI (sGPVI) has received attention as a platelet activation marker. We had prospectively enrolled the 81 consecutive patients who underwent splenectomy (Sx) and/or hepatectomy: these patients were divided as Sx (n = 38) and hepatectomy (Hx, n = 46) groups. The 3 patients who underwent both procedures were added to both groups. Each group was subdivided into patients with non-LC and LC: non-LC-Sx (n = 22) and LC-Sx (n = 16), non-LC-Hx (n = 40) and LC-Hx (n = 6). The presence of PVT was diagnosed by using enhanced computed tomography (CT) scan. Platelet counts were significantly lower in LC-Sx than in non-LC-Sx, and incidence of PVT was significantly higher in LC-Sx than in non-LC-Sx (68.8% vs 31.8%, P = .024). Soluble form of glycoprotein VI /platelet ratios on preoperative day and postoperative day 1 were significantly higher in LC-Sx than in non-LC-Sx. Incidence of PVT was significantly higher in LC-Hx than in non-LC-Hx (50.0% vs 7.5%, P < .01). Soluble form of glycoprotein VI /platelet ratios were significantly higher in LC-Hx before and after Hx, compared to non-LC-Hx. Patients with LC stay in hypercoagulable state together with platelet activation before and after surgery. Under this circumstance, alteration of portal venous blood flow after Sx or Hx is likely to cause PVT in patients with LC.

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

“…It is believed that splenectomy reduces synthesis of coagulation factors in patients with liver cirrhosis, and the scavenging activity of tissue plasminogen activator is decreased resulting in a high blood coagulation state[26]. In addition, the risk of PVT after splenectomy can be caused by lack of microcirculation, increased blood viscosity, blood stasis induced by splenic vein stump, decreased blind pouch postoperative PV pressure, slower blood flow and platelet count[27,28]. The presence of these factors can lead to the formation of PVT and have a continuous impact on the PV system despite treatment with TIPS.…”

Treatment of acute exacerbation of liver-cirrhosis-associated portal vein thrombosis with direct-acting oral anticoagulant, edoxaban, used as an initial treatment in the early postoperative period after abdominal surgery: a case report

“…Prevalence of the CA-PVT has been reported to range 5–30% of cirrhotic patients [ 1 – 4 ]. Furthermore, underlying CA-PVT has been reported to be easily exacerbated by various factors, including abdominal surgery [ 7 , 8 ]. In the present case, although the PVT was considered as CA-PVT, inappropriate management of CL, in which ERBD tube stent was unexchanged during extremely long-term period with more than 9 years, might have had a negative impact on the underlying PVT.…”

“…Of note, enoxaparin was reported to be efficacious for preventing PVT developing after hepatic resection for liver cancers [ 23 ]. Reportedly, new onset PVT in cirrhotic patients and/or exacerbation of CA-PVT is likely to occur after abdominal surgery [ 7 , 8 , 23 ]. Thus, it can be said that we should have used VTE prophylaxis for the present case.…”

“…On the other hand, CA-PVT has been reported to be likely to exacerbate under several situations, including a status after abdominal surgery [ 7 , 8 ]. In such situation, it is still considered that traditional anticoagulation should be used as an initial treatment [ 2 – 4 , 6 – 8 ].…”

“…On the other hand, CA-PVT has been reported to be likely to exacerbate under several situations, including a status after abdominal surgery [ 7 , 8 ]. In such situation, it is still considered that traditional anticoagulation should be used as an initial treatment [ 2 – 4 , 6 – 8 ]. Especially in the early postoperative period after major abdominal surgery, the safety and efficacy of DOAC used as an initial treatment for CA-PVT have not been examined [ 2 – 4 , 6 – 8 ].…”