Antithrombotic Therapy in Non-Neoplastic Chronic Portal Venous Thrombosis in Cirrhosis: Recanalization and Liver Function Evaluation,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3358-3358 ◽  
Author(s):  
Leyre Bento ◽  
Ana Rodriguez Huerta ◽  
Cristina Pascual ◽  
Gloria Pérez Rus ◽  
Vega Catalina ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Function ◽  
Antithrombotic Therapy ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Splenic Vein ◽  
Liver Function Tests ◽  
Vein Thrombosis ◽  
Function Tests ◽  
Portal Trunk

Abstract Abstract 3358 INTRODUCTION: Non-neoplastic chronic portal vein thrombosis (PVT) is a frecuent diagnosis in the course of liver cirrhosis, with reported prevalences of 0.6% to 15,8%. PVT can motivate life-threatening complications due to worsening portal hypertension, so anticoagulation therapy is challenging in these patients. OBJECTIVE: To analyze the response to antithrombotic therapy and changes in liver function tests in 28 patients with chronic PVT associated with cirrhosis. PATIENTS AND METHODS: 28 consecutive patients with liver cirrhosis and chronic PVT were treated with antithrombotic therapy from 2004 to 2009. Hepatocellular carcinoma and known thrombophilic risks were ruled out. Therapy consisted in 15 days of therapeutic doses of low molecular weight heparin (LMWH) (enoxaparin) adjusted according to baseline coagulability (Table 1), followed by either prophylactic doses (40mg/day) of LMWH or acenocoumarol (target INR 2–3), during 6 months. Response was evaluated after 6 months. If recanalization was complete, therapy was suspended. If recanalization was partial or no recanalization was observed, therapy was continued until response. RESULTS: From the 28 patients studied, 19 (68%) were males with a median age of 53 years (range 35–77). Cirrhosis was due to alcoholism (25%), virus (54%), mixed in 1 patient and other causes in 3 patients. PVT involved the portal trunk and/or branches in 19/28 (68%) patients, mesenteric vein in 2 patients and portal trunk and/or branches, mesenteric and/or splenic vein thrombosis coexisted in 7 patients. 19/28 (68%) of the patients had moderate or moderate-severe hypocoagulability range. Complete and partial thrombosis was seen in 18 and 10 patients at diagnosis, respectively. From the 28 patients, 18 (64%) responded to antithrombotic therapy after 6 months, with a complete recanalization in 13 patients 13/18 (72%) and partial in 5/18 patients (28%). None of the 28 patients presented hemorrhagic complications and none showed platelets counts below baseline values. 17 from the 18 patients who responded, showed altered liver function tests before therapy. After 6 months, 8/17 (47%) improved liver function (only one patient had received antiviral therapy). After a median follow up of 42 months (range 7–67), 15/18 (83%) patients continued showing complete or partial response while 3 patients progressed. Of note, 3 patients of this group could proceed to further liver transplantation. CONCLUSIONS: Antithrombotic therapy in chronic PVT in cirrhotic patients resulted in a high response rate (64%) in our study, with a complete recanalization in 72% of the cases. Adjusted dose scheme according to level of hypocoagulability seems to be effective and safe, since 63% of the subgroups of moderate and moderate-severe hypocoagulability responded with no haemorrhagic complications. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Correlationships between Liver Function Tests and Morphometric Cytological Parameters in Liver Cirrhosis.

1994 ◽  
Vol 27 (11) ◽  
pp. 2403-2407
Author(s):  
Katsuhisa Tsuji ◽  
Akio Ishikawa ◽  
Mikio Doi ◽  
Akira Osada ◽  
Yuuki Yamamato ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Function ◽  
Liver Function Tests ◽  
Function Tests

scholarly journals Study of liver function tests and spontaneous bacterial peritonitis in a patients of liver cirrhosis

2020 ◽  
Vol 7 (3) ◽  
pp. 421
Author(s):  
Sangram S. Mangudkar ◽  
Sachin K. Shivnitwar ◽  
Vijayashree S. Gokhale ◽  
Ameya A. Ithape
Keyword(s):  
Liver Cirrhosis ◽  
Liver Function ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Defense Mechanism ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Liver Function Tests ◽  
Bacterial Peritonitis ◽  
Function Tests

Background: Liver cirrhosis patients are highly susceptible to bacterial infections specially Spontaneous bacterial peritonitis (SBP) which is commonest infection. this study undertaken to understand liver function tests and Spontaneous bacterial peritonitis in patients of liver cirrhosis admitted to tertiary care hospital.Methods: A descriptive cross-sectional study conducted among Liver cirrhosis patients in tertiary care center. Total 100 liver cirrhotic patients were included in present study. All the patients were subjected for biochemical evaluation of Serum albumin and globulin level, Serum bilirubin, SGOT (Serum glutamic oxaloacetic transaminase), SGPT (Serum glutamic pyruvate transaminase) and Ascitic fluid polymorph nuclear neutrophil (PMN) count to diagnose SBP.Results: Spontaneous bacterial peritonitis was present in 12% patients. Relation of Serum bilirubin level and SBP was statistically significant. Relation of serum SGOT, SGPT level and serum globulin between SBP and non-SBP group was statistically non-significant.Conclusions: Liver cirrhosis patients are susceptible for bacterial infections because of defects in various host defense mechanism and hence patients of liver cirrhosis must be screened for spontaneous bacterial peritonitis along with liver function tests.

Iron Chelation with Deferasirox in Thalassemia Major Patients with Low Iron Burdens and Moderate to High Transfusion Regimens.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4070-4070
Author(s):  
Elizabeth Evans ◽  
Dorothy A. Kleinert ◽  
Kevin Mennitt ◽  
Robert W. Grady ◽  
Patricia J. Giardina
Keyword(s):  
Renal Function ◽  
Liver Function ◽  
Serum Ferritin ◽  
Conflicts Of Interest ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Thalassemia Major ◽  
Serious Adverse Events ◽  
Liver Iron ◽  
Function Tests

Abstract Abstract 4070 Poster Board III-1005 Introduction A worldwide multicenter clinical trial of deferoxamine (DFO) in comparison to deferasirox (DFX/Exjade) established optimal therapeutic doses of DFX for use in b-thalassemia patients (pts) with moderate to severe iron burdens as determined by serum ferritin levels greater than 1000 ng/mL and liver iron concentrations (LICs) greater than 3 mg/g-dry weight (dw) resulting from regular red blood cell (RBC) transfusion regimens designed to maintain pre-tx hemoglobin (Hgb) levels greater than 9 to 10 gm/dL. To date, the use of DFX in less heavily iron overloaded transfused patients is not well documented. Therefore, we studied the safety and efficacy of DFX at a dose of approximately 20 mg/kg/day in a group of regularly transfused thalassemia major pts who had previously been well chelated with subcutaneous (sc) DFO as evidenced by serum ferritin levels less than 1000 ng/mL and LICs less than 3 mg/gm-dw. Patients The pt group consisted of eight transfusion dependent thalassemia major pts (2M/6F) who ranged in age from 13 to 49 yrs (mean ± SEM 28.3 ± 13.2 yrs). Six of the pts were splenectomized (2M/4F) and maintained on moderate to high transfusion regimens (2 to 4 RBC units per month) so as to maintain a pre-tx Hgb level of 9 to 10 gm/dL. Assessments/Methods Clinical parameters, including pre-tx Hgb levels, RBC units transfused, serum ferritins, liver function tests (ALT/AST), and renal function studies (BUN/creatinine) were determined at baseline and monitored monthly thereafter in all patients for one year. Hearing tests, eye exams and determinations of LIC by T2* magnetic resonance imaging (MRI) were done at baseline and 12 months. Annual tx requirements were calculated and expressed as mL of RBCs/kg/yr. All pts previously infused DFO sc 5 days each week at doses of 40 to 60 mg/kg/day. During the study, they ingested DFX daily 30 minutes prior to breakfast at a dose of 20 to 30 mg/kg as a suspension in water, apple or orange juice. Dose adjustments were made depending upon trends in serum ferritin levels, liver function tests or renal studies. Results Each pt received 2 to 4 leukocyte depleted washed RBC units per month (mean 119 ± 8.2 mL/kg/yr). Their mean pre-tx Hgb levels were 9.7 ± 0.2 gm/dL. Average monthly chemistry parameters were as follows: serum ferritin = 550 ± 9.4 ng/mL; AST = 36 ± 5; ALT = 36 ± 7; BUN = 14.8 ± 1.0; creatinine = 0.7 ± 0.1. There were no significant changes in the parameters related to liver or renal function, or in LICs during the 12-month observation period, the mean LICs were 2.0 ± 0.4 mg/gm-dw at baseline vs. 1.6 ± 0.3 mg/gm-dw at 12 months. Serum ferritin levels also remained stable during the course of therapy (577 ± 71 ng/mL at baseline vs. 480 ± 106 ng/mL at 12 months). The starting dose of DFX ranged from 20 to 30 mg/kg/day. Over the course of the study, the dose was increased to 25 and 30 mg/kg/day in pts 2 and 7, respectively, owing to a progressive increase in serum ferritin levels and decreased to 10 mg/kg in pt 3 and 18 mg/kg in pt 8 due to declining ferritin levels. On average, a dose of 20.5 ± 2 mg/kg/day was needed to maintain iron balance. No serious adverse events occurred during the 12-month course of DFX and no significant side effects (e.g. rash or gastrointestinal symptoms) were reported. Conclusion Moderate doses of DFX, slightly more than 20 mg/kg/day, were safe and effective in maintaining iron balance as measured by LICs (MRI) and serum ferritin levels in thalassemia major patients with low iron burdens (LICs <3 mg/g-dw and serum ferritin levels <1000 ng/mL) receiving regular tx therapy to maintain pre-tx Hgb levels of 9 to 10 gm/dL. Disclosures: No relevant conflicts of interest to declare.

Antithrombotic Therapy in Non-Neoplastic Chronic Portal Venous Thrombosis in Cirrhosis: Evaluation of Recanalization and Safety.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 894-894 ◽  
Author(s):  
Mi Kwon ◽  
Ana Rodriguez-Huerta ◽  
Cristina Pascual ◽  
Manuel Rabadan ◽  
Vega Catalina ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Antithrombotic Therapy ◽  
High Response Rate ◽  
Vein Thrombosis ◽  
Coagulation Study ◽  
Class B ◽  
Cirrhotic Patients ◽  
Complete Thrombosis ◽  
Therapeutic Doses ◽  
Portal Trunk

Abstract INTRODUCTION: Non-neoplastic chronic portal vein thrombosis (PVT) has become a more frecuent diagnosis in the course of liver cirrhosis, with reported prevalences of 4,4% to 15,8%. PVT can motivate life-threatening complications due to worsening portal hypertension. The role of anticoagulation in patients with chronic PVT is not well established, and is considered challenging in cirrhotic patients. OBJECTIVE: To analyze the response to antithrombotic therapy in 12 patients with chronic PVT associated with cirrhosis, and to assess its tolerance and safety. PATIENTS AND METHODS: 12 consecutive patients with liver cirrhosis and chronic PVT were treated with antithrombotic therapy from 2005 to 2006. PVT was diagnosed by imaging procedures, and was classified as complete or partial according to absence or reduction of blood flow in the portal trunk, branches, superior mesenteric and splenic veins. Hepatocellular carcinoma and known thrombophilic risks were ruled out. Cirrhosis was scored according to Child-Pugh’s classification. History of hemorrhagic episodes was assessed. Therapy was started with 15 days of therapeutic doses of low molecular weight heparin (LMWH) (enoxaparin) adjusted according to baseline hipocoagulability (Table 1), followed by either prophylactic doses (0,5mg/kg/day) of LMWH or acenocoumarol (target INR 2–3), during 6 months. Response was evaluated after 3 and 6 months. RESULTS: From the 12 patients studied, 9 (75%) were males with a median age of 52 years old (range 35–72). Cirrhosis was due to alcoholism (41%), virus (33%), mixed in one patient and other causes in two patients. Two (16%) patients belonged to Child Pugh’s class A, 6 (50%) to class B and 4 (33%) to class C. Six patients (50%) had previous hemorrhagic episodes due to esophageal varices. PVT involved the portal trunk and/or branches in 91% of the cases, and in 1 patient coexisted with splenic and mesenteric vein thrombosis. Complete thrombosis was seen in 4 patients and partial in 8. From the 12 patients, 8 (66%) responded to antithrombotic therapy after 6 months, with a complete recanalization in 7 patients (87%). Interestingly, the moderate hipocoagulability level subgroup showed an 88% of response (Table2). After an overall follow-up of 6 months, none of the 12 patients presented hemorrhagic complications and none showed platelets counts below baseline values. Acenocoumarol and LMWH were well tolerated in all cases, with only one patient with intolerance to the subcutaneous injections. CONCLUSIONS: Antithrombotic therapy in chronic PVT in cirrhotic patients showed a high response rate (66%) in our study, with a complete recanalization in 87% of the cases. Adjusted dose scheme according to level of hypocoagulability seems to be effective and safe, since 80% of the subgroup of moderate hypocoagulability responded with no haemorrhagic complications. Table 1. Ranges of baseline coagulation study and adjusted therapeutic doses of LMWH. N, Normal range, LH, Low hypocoagulability; MH, Moderate hypocoagulability. Table 2. Responses rates according to baseline hypocoagulability.

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