Document Detail


Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis.
MedLine Citation:
PMID:  22289875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there are limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT.
METHODS: We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n = 31) or progression of previously known PVT (n = 24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed, and recanalization was evaluated by using Doppler ultrasound, angio-computed tomography, and/or angio-magnetic resonance imaging analyses.
RESULTS: Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed less frequent liver-related events (portal hypertension-related bleeding, ascites, or hepatic encephalopathy) during the follow-up period, but this difference was not statistically significant (P = .1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50 × 109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy.
CONCLUSIONS: Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis.
Authors:
María Gabriela Delgado; Susana Seijo; Ismael Yepes; Linette Achécar; Maria Vega Catalina; Angeles García-Criado; Juan G Abraldes; Joaquín de la Peña; Rafael Bañares; Agustín Albillos; Jaume Bosch; Juan Carlos García-Pagán
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-01-28
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  10     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-16     Revised Date:  2013-05-01    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  776-83     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clínic-Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiography
Anticoagulants / administration & dosage*,  adverse effects*
Axis
Female
Humans
Liver Cirrhosis / complications*
Male
Middle Aged
Portal Vein / pathology*,  radiography,  ultrasonography
Radiography, Abdominal
Tomography, X-Ray Computed
Treatment Outcome
Venous Thrombosis / drug therapy*
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Comment In:
Clin Gastroenterol Hepatol. 2012 Jul;10(7):820-1; author reply 821   [PMID:  22387253 ]
Clin Gastroenterol Hepatol. 2013 Jan;11(1):103   [PMID:  22902778 ]
Clin Gastroenterol Hepatol. 2013 Jan;11(1):103-4   [PMID:  23064025 ]
Gastroenterology. 2013 Apr;144(4):848-51   [PMID:  23491832 ]
Clin Gastroenterol Hepatol. 2012 Jul;10(7):784-5   [PMID:  22469993 ]

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