Thrombosis of the Portal Venous System in Cirrhotic Patients (original) (raw)
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Hepatology, 2015
on behalf of Groupe d'Etude et de Traitement du Carcinome H epatocellulaire In cirrhosis, portal vein thrombosis (PVT) could be a cause or a consequence of the progression of liver disease. We analyzed data from a prospective trial of ultrasound screening for hepatocellular carcinoma in order to identify risk factors for and the impact of PVT in patients with cirrhosis. In all, 1,243 adults with cirrhosis without PVT were enrolled from 43 liver units in France and Belgium between June 2000 and March 2006. The mean follow-up was 47 months. Doppler ultrasonography was used to check the portal vein. Progression of liver disease was defined by the development of: ascites, hepatic encephalopathy, variceal bleeding, prothrombin <45%, serum bilirubin >45 lmol/L, albumin <28 g/L, and/or creatinine >115 lmol/L. G20210A prothrombin and factor V gene mutations were assessed in sera stored at three large centers. The 5year cumulative incidence of PVT was 10.7%. PVT was mostly partial and varied over time. The development of PVT was independently associated with baseline esophageal varices (P 5 0.01) and prothrombin time (P 5 0.002), but not with disease progression before PVT, or prothrombotic mutations. Disease progression was independently associated with baseline age (hazard ratio [HR] 1.55; 95% confidence interval [CI]: 1.11-2.17), body mass index (HR 1.40; 95% CI: 1.01-1.95), prothrombin time (HR 0.79; 95% CI: 0.70-0.90), serum albumin (HR 0.97; 95% CI: 0.94-0.99), and esophageal varices (HR 1.70; 95% CI: 1.21-2.38) but not with the prior development of PVT (HR 1.32; 95% CI: 0.68-2.65). Conclusion: In patients with cirrhosis, the development of PVT is associated with the severity of liver disease at baseline, but does not follow a recent progression of liver disease. There is no evidence that the development of PVT is responsible for further progression of liver disease. (HEPATOLOGY 2015;61:660-667) W ith the increased frequency of liver imaging thanks to accurate, noninvasive techniques, portal vein thrombosis in the absence of malignancy (so-called nonmalignant portal vein thrombosis and thereafter referred to as PVT) is increasingly identified in patients with cirrhosis. The estimated prevalence of PVT in these patients ranges from 0.6 to 26%. 1-3 Although several risk factors have been proposed
Risk factors for portal vein thrombosis development in patients with cirrhosis
2019
Background. Nonmalignant portal vein thrombosis is a significant event in the course of cirrhosis, known to affect the most severe patients. Its impact on liver disease progression or decompensation is not clear but it is known to decrease survival after liver transplantation. Some associated risk factors have been described but are not consensual or have not been validated to date. Aims. To determine i) risk factors for the development of nonmalignant portal vein thrombosis in the context of cirrhosis, and ii) the impact of the thrombotic event on liver disease progression, decompensation or death (secondary aim). Methods. Two prospective observational longitudinal studies were conducted.
Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis
Journal of Hepatology, 2004
Portal vein thrombosis in patients with liver cirrhosis is usually associated to hepatocellular carcinoma. Clinical presentation of non-neoplastic portal vein thrombosis (PVT) in cirrhotic patients has not been specifically studied and risk factors of PVT in this group of patients are still poorly understood.We studied all patients with PVT and liver cirrhosis admitted to our Unit from January 1998 to December 2002. They were paired (by gender, age and Child-Pugh score) to a group of cirrhotic patients without PVT and screened for acquired and inherited thrombophilic risk factors. These factors together with the site of thrombosis and the severity of the liver disease were correlated to the clinical presentation of PVT.Out of a total of 701 cirrhotic patients admitted to our hospital and routinely screened with Doppler ultrasound, 79 (11.2%) were found to have PVT. Of these, 34 (43%) were asymptomatic and 45 (57%) were symptomatic (31 presented with portal hypertensive bleed and 14 with abdominal pain, 10 of whom had intestinal infarction). Mesenteric vein involvement was never asymptomatic and lead to intestinal ischemia or infarction. Most patients were in class Child-Pugh B and C. Among thrombophilic risk factors studied only the mutation 20210 of the prothrombin gene resulted independently associated to PVT.Portal vein thrombosis may be completely asymptomatic in patients with liver cirrhosis; however in more than half of cases presents with life-threatening complications such as gastrointestinal haemorrhage and intestinal infarction. Cirrhotic patients with PVT usually have an advanced liver disease and the presence of the mutation 20210 of the prothrombin gene increases more than fivefold the risk of PVT.
Risk factors of portal vein thrombosis in patients with liver cirrhosis
World Chinese Journal of Digestology, 2008
This study was designed to identify and assess risk factors for portal vein thrombosis (PVT) in patients with cirrhosis. A total of 98 cirrhosis patients with PVT were identified and 101 cirrhosis patients without PVT were chosen as the control group in this retrospective study. Several variables were measured and the two groups PVT and non-PVT were compared statistically. PVT was identified in 98 patients (10%). Significant differences in hematocrit, international normalized ratio, albumin, bilirubin and glucose were determined between the groups (P<0.05). Out of the thrombophilic risk factors in the patients with PVT factor V Leiden was identified in 8.8%, prothrombin gene 6.6% and methylenetetrahydrofolate reductase 2.2%. There was no difference in survival time between groups (P>0.05).
Risk factors associated with portal vein thrombosis in liver cirrhosis: A case-control study
Terapevticheskii arkhiv, 2019
Background. Portal vein thrombosis (PVT) in patients with liver cirrhosis is a common complication associated with adverse outcomes. The aim of the study was to build a predictive model for PVT in cirrhotic patients. Materials and methods. A single centre case-control study was carried out. From the database of 1512 cirrhotic patients 94 with newly diagnosed PVT based on contrast-enhanced computed tomography were referred to the Case group. Malignant PVT was an exclusion criterion. Patients without PVT were stratified and matched according to sex, age and etiology of cirrhosis; case-control ratio was 1 : 3-4. The prevalence of PVT in the database, clinical, laboratory, instrumental parameters of the groups were evaluated. Logistic regression model was used to estimate association between variables and PVT. Results. The overall prevalence of PVT was 6.2% with the highest rates among the patients with HBV infection 16.7%, nonalcoholic steatohepatitis 15.6%, alcohol abuse in combinatio...
Background and objectives: Portal vein thrombosis (PVT) is an increasingly recognized complication of liver cirrhosis. It is associated with worsening liver function, ascites and the occurrence of gastroesophageal variceal bleeding. The aim of this work was to clarify the risk factors, clinical presentation and complications of portal vein thrombosis in Egyptian patients with liver cirrhosis and to study the outcome with and without treatment after 6 months follow up period. Methods: Hospitalized cirrhotic patients (N = 80) were segregated into the PVT and non-PVT groups. PVT was detected by Doppler ultrasonography; each group was divided in two sub groups (A and B) according to presence or absence of HCC respectively. The 2 groups were compared as regards risk factors, clinical presentation and complications. The outcome of treatment with anticoagulation in 6 patients was evaluated. Result: PVT developed as result of combination of both local and systemic risk factors. HCC, abdominal infection especially spontaneous bacterial peritonitis and abdominal intervention were the most important local risk factors. Abnormalities of coagulation system were among systemic risk factors. Most of cases were asymptomatic and accidentally discovered, others presented with upper GIT bleeding or other complications of liver cell failure. Anticoagulant administration was associated with increased incidence of partial or complete recanalization and less mortality without increased risk of bleeding. Conclusion and Recommendations: Portal vein thrombosis occurs mostly in cirrhotic patients with advanced liver disease. HCC is the most common local risk factor in our country. Patients with less prolonged coagulation parameters might be at particular risk for developing PVT, so regular monitoring using Doppler-ultrasound should be carried out in these patients. Development of varices is a time dependent phenomenon; it is advisable to screen all PVT patients endoscopically. Owing to decrease complications, early administration of anticoagulation is advised in selected cases.
Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients
Saudi Journal of Gastroenterology, 2014
The liver plays a central role in maintaining the critical balance between bleeding and thrombotic events. Liver cirrhosis (LC) is characterized by a complex picture of impaired coagulation, thrombocytopenia, decreased pro-and anticoagulant factors produced by the liver, increased von Willebrand factor, factor VIII, and decreased pro-and antifibrinolytic factors, with a low tendency to hyperfibrinolysis. [1,2] Despite clear evidence of an increased tendency for bleeding in patients with liver cirrhosis, in some circumstances these patients are characterized by a hypercoagulable state. [3] The incidence of portal vein thrombosis (PVT) in compensated LC was reported between 0.6% and 5%, and much higher (15%-25%) in decompensated disease. [4-6] There are no data regarding the difference in the prevalence between partial and total PVT in cirrhotic patients. PVT is a serious complication of cirrhosis due to further increase in portal venous pressure and decreased blood flow to the liver, with the risk of variceal bleeding and worsening of the liver function. [7,8] However, the impact of PVT on the natural history of cirrhosis remains unclear. [9,10] Also, the natural course of PVT in patients with LC is not well known. Moreover, there are many asymptomatic cirrhotic patients in whom PVT is detected incidentally on abdominal ultrasound, and it is not established whether such ABSTRACT Background/Aim: Portal vein thrombosis (PVT) has a high incidence in patients with liver cirrhosis and determines a poor prognosis of hepatic disease. The aim of our study was to define the natural course of partial PVT in cirrhotic patients, including survival and decompensation rates. Patients and Methods: We performed a prospective, cohort study, in a tertiary referral center. There were 22 cirrhotic patients with partial nonmalignant PVT, without anticoagulant treatment, who were followed-up between January 2011 and October 2013. All patients were evaluated by Doppler abdominal ultrasound and computed tomography. Kaplan-Meier method was used to determine the difference in clinical events between the study subgroups. Results: After a mean follow-up period of 20.22 months, partial PVT improved in 5 (22.73%), was stable in 11 (50%), and worsened in 6 (27.27%) patients. Hepatic decompensation rate at 6 and 18 months was higher in patients with worsened PVT than in those with stable/improved PVT (50% vs. 25%, P < 0.0001 and 100% vs. 56.25%, P < 0.0001, respectively). The survival rate at 6 months was 66.66% in worsened PVT group vs. 81.25% (P = 0.005) in stable/improved group, and 16.66% vs. 81.25% (P < 0.0001) at 18 months, respectively. Multivariate analysis showed that Model of End-Life Disease was the independent predictor of hepatic decompensation [hazard ratio (HR) 1.42; 95% confidence interval (CI): 1.08-1.87, P = 0.012] and survival (HR 1.76; 95% CI: 1.06-2.92, P = 0.028). Conclusions: Nonmalignant partial PVT remained stable/ improved in over half of cirrhotic patients and aggravated in more than one fourth in whom it negatively influenced the survival and decompensation rates.
Systematic review: portal vein thrombosis in cirrhosis
Alimentary Pharmacology & Therapeutics, 2010
Aliment Pharmacol Ther 31, 366-374Aliment Pharmacol Ther 31, 366-374SummaryBackground As current imaging techniques in cirrhosis allow detection of asymptomatic portal vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with portal vein thrombosis. Although a consensus on noncirrhotic extra-hepatic portal vein thrombosis has been published, no such consensus exists for portal vein thrombosis with cirrhosis.Aim To perform a systematic review of nonmalignant portal vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management.Methods Studies were identified by a search strategy using MEDLINE and EMBASE.Results Portal vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of portal vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of portal vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options.Conclusions Portal vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.Background As current imaging techniques in cirrhosis allow detection of asymptomatic portal vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with portal vein thrombosis. Although a consensus on noncirrhotic extra-hepatic portal vein thrombosis has been published, no such consensus exists for portal vein thrombosis with cirrhosis.Aim To perform a systematic review of nonmalignant portal vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management.Methods Studies were identified by a search strategy using MEDLINE and EMBASE.Results Portal vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of portal vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of portal vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options.Conclusions Portal vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.
Portal vein thrombosis in cirrhosis: diagnosis, natural history, and therapeutic challenges
Annals of gastroenterology
Portal vein thrombosis (PVT) is a frequent complication in cirrhosis and its prevalence increases with disease severity. Several factors are involved in the development and progression of PVT. The challenge for the management of PVT is the precise evaluation of the bleeding risk as opposed to life-threatening extension of thrombosis. Nevertheless, the impact on the progression and outcome of liver disease is unclear. A critical evaluation of the available data discloses that treating PVT in cirrhotics is safe and effective. However, there are open issues, such as which anticoagulant could represent a safer therapeutic option, and when and for how long this treatment should be administered to cirrhotic patients with PVT.
Determine the Frequency of Portal Vein Thrombosis in Patients with Liver Cirrhosis
Pakistan Journal of Medical and Health Sciences, 2021
Objective: The aim of this study is to determine the frequency of portal vein thrombosis in patients with liver cirrhosis. Study Design: Retrospective/Case-control Place and Duration: Medicine and Gastroenterology department of Peshawar Institute of Medical Sciences, Peshawar and DHQ Teaching Hospital, Charsadda for six months duration from August 2020 to January 2021. Methods: Total 100 patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking written consent, Patients were aged between 20-75 years. Patients who had liver cirrhosis were included in this study. Complete patients were undergone for Doppler ultrasonography for observation of portal vein thrombosis. Complete data was analyzed by SPSS 24.0 version. Results: Out of 100 patients, 60 (60%) were males and 40 (40%) patients were females. Mean age of the patients were 47.08±7.42 years with mean BMI 28.22±9.61kg/m2. We found that 60 (60%) patie...