Portal vein thrombosis, cirrhosis, and liver transplantation

Francoz, Claire; Valla, Dominique; Durand, François

doi:10.1016/j.jhep.2011.12.034

Cited by 223 publications

(288 citation statements)

References 76 publications

(149 reference statements)

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“…Factors predicting recanalization were recent onset (<6 months) of the thrombus and partial PVT [211][212][213]. Treatment prolongation resulted in higher rates of recanalization and a lower likelihood of extension.…”

Section: Anti-coagulation For the Prevention/treatment Of Portal Veinmentioning

confidence: 97%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Anti-coagulation For the Prevention/treatment Of Portal Veinmentioning

confidence: 97%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…Hepatic encephalopathy may be seen in 4-27% and TIPS dysfunction in 20-38% of patients. 164 Long term anticoagulation use varies from 11 to 100% due to study designs. 164 Studies have shown long term patency rates even without anticoagulation in TIPS, hence routine anticoagulant use may not be recommended after TIPS placement except in those patients with prothrombotic states.…”

Section: Tipsmentioning

confidence: 99%

“…164 Long term anticoagulation use varies from 11 to 100% due to study designs. 164 Studies have shown long term patency rates even without anticoagulation in TIPS, hence routine anticoagulant use may not be recommended after TIPS placement except in those patients with prothrombotic states. In a few cases with PVT, TIPS has been shown to be successful 165,166 in treating patients with portal biliopathy and portal vein thrombosis complicating Budd-Chiari syndrome.…”

Section: Tipsmentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

150

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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“…Repeated imaging at specified intervals, usually every 3 months, during the pre-transplant waiting period is also recommended in order to detect thrombosis that may develop during follow-up. 47 Patients who develop unexplained worsening of liver functions or gastrointestinal bleeding despite adequate prophylaxis should also be evaluated for new onset PVT. Both Doppler ultrasonography and multiphasic computed tomography have high sensitivity and specificity for detection of PVT.…”

Section: Diagnosis Of Pvt In Cirrhosismentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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Portal vein thrombosis, cirrhosis, and liver transplantation

Cited by 223 publications

References 76 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Portal Vein Thrombosis

Portal Vein Thrombosis in Cirrhosis

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