Treatment of acute portal vein thrombosis by nontraditional anticoagulation

Martínez, Melissa; Tandra, Anand; Vuppalanchi, Raj

doi:10.1002/hep.26998

Cited by 79 publications

(51 citation statements)

References 5 publications

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“…2,3 The report from Intagliata et al of five patients with compensated cirrhosis (Child-Pugh Class A) emphasizing the safety and efficacy of rivaroxaban and apixaban for treatment of acute PVT/ SMV is very encouraging. Similar to our experience (Child-Pugh Class A), complete resolution of the thrombus required a treatment duration of 6 months.…”

Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

“…1 Two recent reports in HEPATOLOGY suggested efficacy and safety of new-generation oral anticoagulant drugs (the direct factor Xa inhibitors, Rivaroxaban and Apixaban) in treatment of PVT in patients with compensated cirrhosis. 2,3 These new drugs have practical advantages over traditional anticoagulants. 4 We recently showed altered in vitro potency of different anticoagulant drugs in patients with cirrhosis, compared to patients with intact liver function.…”

Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

“…Use of rivaroxaban and not apixaban would be associated with increased anticoagulant activity. 3 While in vitro studies use platelet-poor plasma with the addition of phospholipids as a substitute in the presence of thrombomodulin, these assays only partially mimic in vivo physiology. Studies using whole blood clotting assays such as thromboelastography that reflect overall hemostatic balance would need to be performed to better understand the anticoagulant potency of factor Xa inhibitors in patients with cirrhosis with decompensated liver disease.…”

Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

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Decreased in vitro anticoagulant potency of Rivaroxaban and Apixaban in plasma from patients with cirrhosis

2015

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Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

Section: Decreased In Vitro Anticoagulant Potency Of Rivaroxaban Andmentioning

confidence: 99%

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Decreased in vitro anticoagulant potency of Rivaroxaban and Apixaban in plasma from patients with cirrhosis

2015

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“…There was complete dissolution of the clot on repeat imaging at 6 months. 145 Due to its predominant hepatic metabolism it is currently contra indicated in Child B and C cirrhosis, coagulopathy and clinically relevant bleeding risk. Another case of successful treatment of portal vein thrombosis has also been reported with rivaroxaban.…”

Section: Portal Vein Thrombosis In Cirrhosis Anticoagulation In Cirrhmentioning

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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“…We read with interest the recent report by Martinez et al 1 showing successful treatment of acute portal vein thrombosis (PVT) with rivaroxaban in a patient with compensated cirrhosis.…”

Section: Treating Thrombosis In Cirrhosis Patients With New Oral Agenmentioning

confidence: 99%