OC.03.6 ANTICOAGULATION THERAPY FOR NON MALIGNANT PORTAL VEIN THROMBOSIS IN CIRRHOTIC PATIENTS: A SAFE TREATMENT?

Abstract Background The standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years. Case presentation Case 1 A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection. Case 2 A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery. Conclusions Although edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.

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Portal vein thrombosis in hepatitis C virus-related cirrhotic patients: Prevalence and clinical characteristics in an Egyptian cohort

Tropical Doctor ◽

10.1177/0049475521998509 ◽

2021 ◽

pp. 004947552199850

Author(s):

Omkolsoum Alhaddad ◽

Maha Elsabaawy ◽

Omar Elshaaraawy ◽

Mohamed Elhalawany ◽

Mohamed Mohamed Houseni ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Clinical Characteristics ◽

Abdominal Ultrasound ◽

Focal Lesion ◽

Vein Thrombosis ◽

Doppler Study ◽

Cirrhotic Patients

Portal vein thrombosis is a catastrophe not uncommonly complicating hepatitis C virus-related liver cirrhosis. To estimate its prevalence and clinical characteristics, we investigated 1000 cirrhotic patients by abdominal ultrasound or Doppler study at least. Portal vein thrombosis was found in 21.6%, of whom 157 (72.7%) had malignancy. Complete portal vein thrombosis was found in 70.4%. Half of all these patients had at least one episode of portal hypertensive bleeding, a third had abdominal pain and a quarter presented with jaundice. Portal bilopathy was diagnosed in two cases (0.9%). There was significant association between severity of liver disease, ascites, male gender and site of segmental focal lesion and portal vein thrombosis.

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Balloon Occlusion Retrograde Transvenous Obliteration of Gastric Varices in Two Non-Cirrhotic Patients with Portal Vein Thrombosis

Korean Journal of Radiology ◽

10.3348/kjr.2014.15.1.108 ◽

2014 ◽

Vol 15 (1) ◽

pp. 108 ◽

Cited By ~ 7

Author(s):

Peyman Borghei ◽

Seung Kwon Kim ◽

Darryl A Zuckerman

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Gastric Varices ◽

Balloon Occlusion ◽

Vein Thrombosis ◽

Cirrhotic Patients

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Efficacy of Transjugular Intrahepatic Portosystemic Shunt to Prevent Total Portal Vein Thrombosis in Cirrhotic Patients Awaiting for Liver Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2012.09.050 ◽

2012 ◽

Vol 44 (9) ◽

pp. 2603-2605 ◽

Cited By ~ 25

Author(s):

D. D'Avola ◽

J.I. Bilbao ◽

G. Zozaya ◽

F. Pardo ◽

F. Rotellar ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Vein Thrombosis ◽

Intrahepatic Portosystemic Shunt ◽

Cirrhotic Patients

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Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

Gut ◽

10.1136/gutjnl-2017-314634 ◽

2017 ◽

Vol 67 (12) ◽

pp. 2156-2168 ◽

Cited By ~ 38

Author(s):

Yong Lv ◽

Xingshun Qi ◽

Chuangye He ◽

Zhengyu Wang ◽

Zhanxin Yin ◽

...

Keyword(s):

Portal Hypertension ◽

Adverse Events ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Decompensated Cirrhosis ◽

Covered Stents ◽

Band Ligation ◽

Vein Thrombosis ◽

Cirrhotic Patients ◽

Endoscopic Band Ligation

ObjectiveLimited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.DesignConsecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.ResultsDuring a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.ConclusionCovered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.Trial registration numberClinicalTrials.gov: NCT01326949.

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The impact of portal vein thrombosis on the prognosis and liver function of nonmalignant cirrhotic patients

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2018.1503327 ◽

2018 ◽

Vol 53 (10-11) ◽

pp. 1340-1346 ◽

Cited By ~ 1

Author(s):

Kei Endo ◽

Takayoshi Oikawa ◽

Keisuke Kakisaka ◽

Akio Tamura ◽

Shigeru Ehara ◽

...

Keyword(s):

Liver Function ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Vein Thrombosis ◽

Cirrhotic Patients ◽

The Impact

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Low Molecular Weight Heparin in Portal Vein Thrombosis of Cirrhotic Patients: Only Therapeutic Purposes?

The Scientific World JOURNAL ◽

10.1155/2014/895839 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Raffaele Licinio ◽

Mariabeatrice Principi ◽

Giuseppe Losurdo ◽

Nicola Maurizio Castellaneta ◽

Enzo Ierardi ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

High Rate ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

If Current ◽

General Feeling ◽

Cirrhotic Patients ◽

Current Guidelines ◽

Hepatic Synthesis

Cirrhosis has always been regarded as hemorrhagic coagulopathy caused by the reduction in the hepatic synthesis of procoagulant proteins. However, with the progression of liver disease, the cirrhotic patient undergoes a high rate of thrombotic phenomena in the portal venous system. Although the progression of liver failure produces a reduction in the synthesis of anticoagulant molecules, a test able to detect the patients with hemostatic balance shifting towards hypercoagulability has not yet been elaborated. The need of treatment and/or prophylaxis of cirrhotic patients is demonstrated by the increased mortality, the risk of bleeding from esophageal varices, and the mortality of liver transplantation, when portal vein thrombosis (PVT) occurs even if current guidelines do not give indications about PVT treatment in cirrhosis. In view of the general feeling that the majority of cirrhotic patients at an advanced stage may be in a procoagulant condition (suggested by the sharp increase in the prevalence of PVT), it is presumable that a prophylaxis of this population could be of benefit. The safety and the efficacy of prophylaxis and treatment with enoxaparin in patients with cirrhosis demonstrated by a single paper suggest this option only in controlled trials and, currently, there are no sufficient evidences for a recommendation in the clinical practice.

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