Portal Hypertension–Related Complications After Acute Portal Vein Thrombosis: Impact of Early Anticoagulation

Turnés, Juan; García‐Pagán, Juan Carlos; González, M.; Aracil, Carles; Calleja, José Luís; Ripoll, Cristina; Abraldes, Juan G.; Bañares, Rafael; Villanueva, Carmen Navarro; Albillos, Agustı́n; Ayuso, Juan Ramón; Gilabert, Rosa; Bosch, Jaime

doi:10.1016/j.cgh.2008.07.031

Cited by 175 publications

(175 citation statements)

References 22 publications

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“…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.…”

Section: Acute Non-cirrhotic Portal Vein Thrombosis Procoagulant Statementioning

confidence: 99%

“…Recanalization decreases from 69% when anticoagulation was instituted within first week to 25% when instituted at 2nd week. 13 Thirty five percent of acute PVT show recanalization with early anticoagulation. 13,45,111 In another study early anticoagulation could achieve recanalization in 12 of 27 (40%) patients without cirrhosis and malignancy compared with none of the 11 patients who were not given anticoagulation.…”

Section: Anticoagulationmentioning

confidence: 99%

“…114 Early anticoagulation in mesenteric and portal vein thrombosis minimizes serious complications like peritonitis due to bowel necrosis and also significantly decreases the development of esophageal varices related complications. 13,121 The outcome of portal vein thrombosis in adults has been studied in relation to anticoagulation. Out of 136 patients of non-cirrhotic non-malignant portal vein thrombosis, 84 received anticoagulation.…”

Section: Anticoagulationmentioning

confidence: 99%

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Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

143

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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Section: Acute Non-cirrhotic Portal Vein Thrombosis Procoagulant Statementioning

confidence: 99%

Section: Anticoagulationmentioning

confidence: 99%

Section: Anticoagulationmentioning

confidence: 99%

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Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

143

147

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“…37 The purpose of anticoagulation is not only to allow recanalisation of the thrombosed vessel but to prevent thrombus extension. 38 A 2010 multicentre study, which followed up patients for 2 years, noted that anticoagulation did not have any effect on recanalisation beyond 6 months. They found two independent factors predicted the failure of recanalisation: presence of ascites and hypercoagulability.…”

Section: Anticoagulationmentioning

confidence: 99%

“…Delaying until the second week decreases the rate of recanalisation from 69% to 25%. 38 Early anticoagulation also minimises the risk of serious complications, such as bowel necrosis leading to peritonitis, developing. 40 Although 6 months of anticoagulation may be adequate in many patients, it may be beneficial to continue anticoagulation for longer than 6 months in some cases.…”

Section: Anticoagulationmentioning

confidence: 99%