New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

2020 ◽  
Vol 46 (06) ◽  
pp. 673-681 ◽  
Author(s):  
Oana Nicoară-Farcău ◽  
Guillem Soy ◽  
Marta Magaz ◽  
Anna Baiges ◽  
Fanny Turon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Current Knowledge ◽  
Current Evidence ◽  
Special Focus ◽  
Vein Thrombosis ◽  
Frequent Event ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of

AbstractPortal vein thrombosis (PVT) is a frequent event in patients with cirrhosis regardless of etiology. Notwithstanding the commonality of the problem, the pathophysiology and risk factors for PVT in cirrhosis are largely unknown. The clinical impact of PVT in the natural history of cirrhosis is unclear, indications for PVT treatment are not well defined, and treatment recommendations are based on experts' opinion and consensus only. Therefore, this review aims to summarize current knowledge of mechanisms and risk factors for PVT development and assess the current evidence of PVT management, with a special focus on strategies of anticoagulation and transjugular intrahepatic portosystemic shunt placement.

scholarly journals Anticoagulant therapy in patients with liver cirrhosis and portal vein thrombosis: insights for the clinician

2018 ◽  
Vol 11 ◽  
pp. 175628481879356 ◽  
Author(s):  
Stefania Basili ◽  
Daniele Pastori ◽  
Valeria Raparelli ◽  
Francesco Violi
Keyword(s):  
Liver Cirrhosis ◽  
Natural History ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vitamin K Antagonists ◽  
Current Evidence ◽  
Vein Thrombosis ◽  
Long Term Treatment ◽  
History Of ◽  
The Impact

Portal vein thrombosis (PVT) is a frequent complication in the natural history of patients with liver cirrhosis (LC). The prevalence of PVT in LC is highly variable, ranging from 0.6% to 25% according to different reports. The impact of PVT on the natural history of LC is unclear, but it seems to negatively affect the prognosis of patients undergoing liver transplantation (LT) by increasing post-LT mortality and delaying waiting time. The antithrombotic treatment of PVT is still challenging as PVT may often remain asymptomatic and incidentally diagnosed, and a spontaneous partial/total regression of PVT is observed in an important proportion of patients, even in the absence of anticoagulation. Recent evidence suggested that the anticoagulant treatment for PVT may favorably affect both ischemic and bleeding outcomes in LC patients. Anticoagulant therapies so far available include unfractioned heparin, low molecular weight heparins (LMWHs) and fondaparinux for acute treatment, and LMWHs and vitamin K antagonists (VKAs) for long-term treatment. No robust data currently support the use of direct oral anticoagulants (DOACs) in patients with LC and PVT, as the safety and efficacy of DOACs in this setting is still unclear. This review summarizes current evidence for the evaluation and management of patients with LC and PVT.

scholarly journals Risk Factors of Portal Vein Thrombosis after Devascularization Treatment in Patients with Liver Cirrhosis: A Nested Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Shenxin Lu ◽  
Guohua Hu ◽  
Shiyao Chen ◽  
Jian Wang
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
White Blood Cell ◽  
Gastric Varices ◽  
Trunk Diameter ◽  
Vein Thrombosis ◽  
History Of

Background and Aim. To investigate the incidence of portal vein thrombosis (PVT) after devascularization treatment and to explore the risk factors of perioperative PVT and PVT diagnosed during the follow-up period after surgery. Methods. We retrospectively reviewed medical records from cirrhosis patients who underwent devascularization for the treatment of portal hypertension in our hospital between January 1, 2008, and December 20, 2014. Patients were followed up to investigate the PVT incidence at different times after surgery. Patients were divided into two groups (PVT, no PVT), and the risk factors for PVT after surgery were determined. Results. Until October 16, 2015, the median follow-up time of the 124 patients enrolled into this study was 41.43 months (range, 5.47–95.30 months). 61 patients had perioperative PVT, and 21 (16.94%) patients had PVT diagnosed during the follow-up period. Those who had lower preoperative white blood cell counts, larger preoperative portal vein trunk diameter, and no gastric varices were more likely to have perioperative thrombosis. In those without perioperative PVT, a history of hypertension, higher grade of splenomegaly, and higher preoperative levels of creatinine were independent predictors of PVT occurrence during the follow-up period. Conclusions. The risk factors for perioperative PVT in cirrhotic patients after devascularization were lower preoperative white blood cell count and larger portal vein trunk diameter, with no gastric varices. A history of hypertension, a larger spleen, and higher preoperative creatinine level are independent predictors of PVT during follow-up after surgery in patients without perioperative PVT.

scholarly journals Portal Vein Thrombosis in Patients With Cirrhosis Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors, Warfarin Efficacy, and Clinical Outcomes

2017 ◽  
Vol 24 (3) ◽  
pp. 462-470 ◽  
Author(s):  
Wan Yue-Meng ◽  
Yu-Hua Li ◽  
Hua-Mei Wu ◽  
Jing Yang ◽  
Li-Hong Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Vein ◽  
Clinical Outcomes ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Survival Rates ◽  
Preventive Therapy ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt

Portal vein thrombosis (PVT) is a common complication in cirrhosis. The aim of this study was to determine risk factors for PVT, assess the efficacy of anticoagulant therapy, and evaluate the effects of PVT on patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt (TIPSS). A total of 101 patients with cirrhosis undergoing elective TIPSS were prospectively studied. After TIPSS, all patients received preventive therapy for PVT and were followed up at 3, 6, 12, and 24 months. Clinical outcomes were compared between patients who developed PVT after TIPSS and those who did not. Multivariate analysis showed that white blood cell count (relative risk [RR]: 0.377; 95% confidence interval [CI]: 0.132-0.579; P = .001), Child-Turcotte-Pugh score (RR: 1.547; 95% CI: 1.029-2.365; P = .032), and ascites (RR: 1.264; 95% CI: 1.019-1.742; P = .040) were independent predictors for PVT. Warfarin treatment within 12 months achieved significantly higher rates of complete recanalization than aspirin or clopidogrel in patients with PVT (54.5% vs 31.3%; P = .013), although adverse events were similar between the 2 groups ( P > .05). Patients without PVT had significantly lower 2-year cumulative rates of variceal rebleeding (15.9% vs 36.6%; P = .023), shunt dysfunction (27.0% vs 46.8%; P = .039), hepatic encephalopathy (24.1% vs 42.6%; P = .045), and hepatocellular carcinoma (11.4% vs 31.2%; P = .024) and markedly higher 2-year cumulative survival rates (89.8% vs 72.9%; P = .041) than those with PVT. The PVT is associated with poorer clinical outcomes in TIPSS-treated patients, and warfarin is both safe and more effective in recanalizing PVT than aspirin or clopidogrel.

scholarly journals MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

2017 ◽  
Vol 01 (01) ◽  
pp. 20-26
Author(s):  
Abbas Chamsuddin ◽  
Lama Nazzal ◽  
Thomas Heffron ◽  
Osama Gaber ◽  
Raja Achou ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right ◽  
Minilaparotomy Approach ◽  
Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation

2004 ◽  
Vol 18 (4) ◽  
pp. 390-394 ◽  
Author(s):  
Yu Fan Cheng ◽  
Chao Long Chen ◽  
Tung Liang Huang ◽  
Tai Yi Chen ◽  
Yaw Sen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Vein Thrombosis

scholarly journals Risk factors and impact of portal vein thrombosis in liver transplantation

2019 ◽  
Vol 111 ◽  
Author(s):  
Lorena Reyes ◽  
José Ignacio Herrero ◽  
Fernando Rotellar Sastre ◽  
José Antonio Páramo
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vein Thrombosis

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunt for the Management of Portal Vein Thrombosis in Cirrhosis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yong Lv ◽  
Wei Bai ◽  
Kai Li ◽  
Zhengyu Wang ◽  
Wengang Guo ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt
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