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Splanchnic vein thrombosis and variceal rebleeding in patients with cirrhosis.
MedLine Citation:
PMID:  23114742     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: Splanchnic vein thrombosis (SVT) affects the short-term prognosis of acute variceal bleeding in cirrhotic patients. This study evaluated whether SVT also affects the rebleeding rate of patients included in a program of secondary prophylaxis after variceal bleeding.
PATIENTS AND METHODS: A total of 387 patients with variceal bleeding were included from January 2001 to December 2010. Band ligation was carried out every 3-4 weeks. Follow-up included endoscopy at 1, 3, and every 6 months, Echo-Doppler, and biochemical examination every 6 months. From 2005, patients with SVT received anticoagulation with enoxaparin 200 UI/kg/day for at least 6 months. The therapy was started after variceal eradication.
RESULTS: SVT was diagnosed in 41 patients at variceal bleeding, in eight before and in 18 patients during the follow-up. Variceal eradication was achieved in 89.2 and 86.6% in no-SVT and SVT patients. Rebleeding occurred in 9.5 and 11.9% of no-SVT and SVT patients at 12 months. Varices relapsed more frequently in SVT than in no-SVT patients (25.4 vs. 14.67%, P=0.03). The rates of variceal rebleeding and relapse were similar in patients who received or did not receive anticoagulation, but mortality was significantly lower in patients who received anticoagulation.
CONCLUSION: SVT favors the relapse of esophageal varices, but rebleeding can be effectively prevented by standard scheduled band ligations. Anticoagulation does not prevent variceal relapse. The improvement in the survival of patients treated with anticoagulation needs to be confirmed in future studies.
Authors:
Lucio Amitrano; Maria A Guardascione; Mariano Scaglione; Antonella Menchise; Rossana Martino; Francesco Manguso; Alfonso G Lanza; Filippo Lampasi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  24     ISSN:  1473-5687     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1381-5     Citation Subset:  IM    
Affiliation:
aGastroenterology Unit bHepatology Unit, AORN A. Cardarelli cDepartment of Radiology, Pineta Grande Medical Center, Castel Volturno, Naples Italy.
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