Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study (original) (raw)
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Portal vein thrombosis; risk factors, clinical presentation and treatment
BMC Gastroenterology, 2007
Background: Portal vein thrombosis (PVT) is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. The aim of this retrospective study was to describe risk factors, clinical presentation, complications and treatment of portal vein thrombosis in a single-centre.
Hepato-gastroenterology
No definitive evidence exists regarding the treatment of acute portal vein thrombosis (PVT). Treatment modalities that have been employed and investigated include conservative management, anticoagulation, thrombolysis and thrombectomy. This observational study examines the impact of anticoagulation on PVT. The electronic radiology database was searched with keywords 'portal vein' and 'thrombosis'. Relevant patient notes and imaging were reviewed to collect data from those with acute PVT. The primary end point was portal vein recanalisation. Secondary outcome measures were morbidity and the development of portal hypertension and its sequelae (including variceal bleeding). Data from patients with PVT in the context of cirrhosis, malignancy or liver transplant were excluded. Partial or complete recanalization of the portal vein occurred in 81.8% of anticoagulated patients and 37.5% of the non-treatment group. Five patients died, 1 following an intracranial haemorrhage w...
Review article: portal vein thrombosis - new insights into aetiology and management
Alimentary Pharmacology and Therapeutics, 2005
Portal vein thrombosis may occur in the presence or absence of underlying liver disease, and a combination of local and systemic factors are increasingly recognized to be important in its development. Acute and chronic portal vein thrombosis have traditionally been considered separately, although a clear clinical distinction may be difficult. Gastrooesophageal varices are an important complication of portal vein thrombosis, but they follow a different natural history to those with portal hypertension related to cirrhosis. Consensus on optimal treatment continues to be hampered by a lack of randomized trials, but recent studies demonstrate the efficacy of thrombolytic therapy in acute thrombosis, and the apparent safety and benefit of anticoagulation in patients with chronic portal vein thrombosis.
Portal vein thrombosis: A concise review (Review)
Experimental and Therapeutic Medicine, 2021
Portal vein thrombosis (PVT) is a frequent complication in cirrhotic patients, but it may also exist as a basic vascular condition even without any liver damage. Local and systemic factors play a significant role in the pathogenesis of PVT; yet, in practice, more than one factor may be identified. PVT can be considered a result of liver fibrosis and hepatic insufficiency. The JAK2 mutation has been accepted as a factor producing PVT. In general, the anticoagulants are recommended but this therapy should be used carefully in treating patients that associate coagulopathy or thrombocytopenia and esophageal varices. Acute PVT without bowel infarction has a good prognosis. In liver cirrhosis, the mortality due to hemorrhage is higher than in chronic PVT. Therefore, for the patients with PVT, the survival rate is decreased by 55% in two years, due to hepatic insufficiency. Regarding the treatment, LMWH (low molecular weight heparine) is the most utilized in patients with cirrhosis, non-malignancies, infections, or those who are awaiting a liver transplant. DOACs (direct-acting oral anticoagulants) may be used in the rest of the medical conditions, being safe and equal to LMWH.
Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment
World Journal of Gastroenterology, 2010
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient's outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients' future prognoses.
Portal vein thrombosis (PVT): A study of 20 non-irrhotic cases
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
Portal and mesenteric venous thrombosis (PVT) is an uncommon disease with serious consequences if not discovered early in order to prevent complications such as variceal bleeding and intestinal ischaemia. The objective of this study was to describe the clinical presentation and outcome of patients with PVT with a view to early diagnosis and treatment of this disease. The study was restricted to patients with PVT not caused by underlying liver cirrhosis. To analyse important clinical characteristics of this entity we performed a retrospective study of 20 non-cirrhotic patients seen in our hospital from February 1998 to March 2003. The main clinical symptom was abdominal pain (13 patients, 86%), sometimes in combination with diarrhoea and vomiting (5 patients, 33%), nausea and anorexia (3 patients). Laboratory signs were non-specific and diagnosis was usually by computed tomography (19 patients, 95%). Causative factors included prothrombotic states (9 patients, 45%) and/or local facto...
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.
Non Cirrhotic Portal Vein Thrombosis: Diagnostic and Therapeutic Challenge
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Portal vein thrombosis (PVT), the second most common cause of portal hypertension, can be found in cirrhosis and non-cirrhosis patients. Various factors can cause non-cirrhosis PVT, such as biliary infection. Upper gastrointestinal bleeding without sign of liver failure, must be considered as non-cirrhosis PVT manifestation. Combining physical, laboratory, endoscopic and radiological examination is needed to establish the diagnosis of PVT. The principle of PVT management consists of 3 keypoints. They are prevention and treatment of gastrointestinal bleeding, prevention of recurrent thrombosis and portal cholangiopathy therapy. Many aspect should be considered regarding the administration of anticoagulants in PVT patients, especially chronic PVT with cavernomas.