Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis

Amitrano, Lucio; Guardascione, Maria Anna; Menchise, A.; Martino, R.; Scaglione, Mariano; Giovine, S; Romano, Luigia; Balzano, A.

doi:10.1016/j.dld.2008.12.047

Cited by 60 publications

(96 citation statements)

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“…Regarding the efficacy and safety of anti-coagulant therapy in patients with cirrhosis and established PVT, available data consist of 5 case series with a total of 163 subjects [204,[207][208][209][210]: at month 6 of therapy, complete or partial recanalization occurred in 33-45% of patients, while extension of the thrombus was observed in <10%. Factors predicting recanalization were recent onset (<6 months) of the thrombus and partial PVT [211][212][213].…”

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

confidence: 99%

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: 99%

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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“…In individuals with partial response to therapy, complete PV recanalization was achieved in 86% with continuation of enoxaparin for six more months. 60 In most studies, recanalization is uncommon in patients with complete thrombosis, but anticoagulation still prevented the extension of the thrombus. 3,[58][59][60] An important objective in the management of PVT in cirrhotic patients awaiting liver transplantation is to achieve recanalization so that conventional end-to-end portal vein anastomosis is surgically possible.…”

Section: Anticoagulant Therapymentioning

confidence: 99%

“…60 In most studies, recanalization is uncommon in patients with complete thrombosis, but anticoagulation still prevented the extension of the thrombus. 3,[58][59][60] An important objective in the management of PVT in cirrhotic patients awaiting liver transplantation is to achieve recanalization so that conventional end-to-end portal vein anastomosis is surgically possible. Another objective is to prevent extension of the thrombus to the splenic and superior mesenteric vein, since these veins can also be used to restore portal flow to the graft in case the main PV is thrombosed.…”

Section: Anticoagulant Therapymentioning

confidence: 99%

“…29,63 The impact of PVT on the natural history of cirrhosis is still a matter of great debate and the clinical benefits of PV recanalization have been very well demonstrated. 60 Despite this, there is evidence that cirrhotic individuals with PVT on the waiting list for liver transplantation should be treated with anticoagulation therapy. Complete or partial PV recanalization has been associated with a better 2-year survival rate after liver transplantation (82-83%) compared to individuals with complete PVT (50%).…”

Section: Selection Of Patients For Anticoagulationmentioning

confidence: 99%

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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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“…There is a potential risk of further lowering of protein C and they are associated with extensive drug interactions. [22][23][24][25] The aims of anticoagulation are to achieve recanalization of the portal vein and to prevent extension of the thrombus to the splenic and superior mesenteric vein. A recanalized portal vein allows a conventional end-to-end portal venous anastomosis without adding to the complexity of orthotopic liver transplantation (OLT).…”

Section: Correct Answers: C and Ementioning

confidence: 99%