Non tumoral portal vein thrombosis during cirrhosis: Should anticoagulation be proposed?

Mapping Intimacies ◽

10.32512/jmr.1.2.2018/4.11. ◽

2018 ◽

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulant Therapy ◽

Control Group ◽

Case Group ◽

Early Introduction ◽

Vein Thrombosis ◽

History Of ◽

One Year ◽

The Impact

Background: Portal vein thrombosis (PVT) is considered as infrequent and pejorative event in cirrhosis. Up to date, many questions remain about therapeutic management. Aim: The objectives of this study were to assess the impact of the PVT on the progression of liver disease, to review the indications for anticoagulation and its repercussions. Materials and methods: A case-control study was conducted over a period of 12 years (2002-2013). It included 484 cases of cirrhosis. Among these patients, 41 had non tumoral portal vein thrombosis (case group). The control group included the remaining 443 patients. Results: In our study, there was no impact of PVT on the natural history of cirrhosis both in terms of complications or survival. Only the early introduction of anticoagulant therapy was associated with a re-permeabilization of portal vein at one year (OR1.6; 95% CI [1.10-2.01]). Prolonged anticoagulation was inversely correlated with recurrent PVT after treatment. However, obtaining a portal vein re-permeabilization was not correlated to a significant gain in terms of prevention of complication related to cirrhosis and survival. Conclusions: results suggest that portal vein thrombosis in patients with cirrhosis is not a formal indication for anticoagulant therapy. It should be reserved for candidates of liver transplantation, those with an extension of the PVT to mesenteric vessels or with severe prothrombotic status. Key words: portal vein thrombosis, cirrhosis, anticoagulation.

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Safety and Efficacy of Anticoagulation in Patients with Cirrhosis: A Meta-Analysis

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8859602 ◽

2021 ◽

Vol 2021 ◽

pp. 1-20

Author(s):

Huan Chen ◽

Jiaming Lei ◽

Sicheng Liang ◽

Gang Luo ◽

Mingming Deng ◽

...

Keyword(s):

Liver Cirrhosis ◽

Adverse Events ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulant Therapy ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Safety And Efficacy ◽

Vein Thrombosis

Background and Aims. Portal vein thrombosis is a serious adverse event that occurs during liver cirrhosis. We performed a meta-analysis to evaluate the safety and efficacy of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with (/without) portal vein thrombosis. Methods. Eligible comparative studies were identified by searching the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI. A meta-analysis was performed to calculate odds ratios and 95% confidence intervals using fixed-effects models. Recanalization and thrombus progression were defined as the primary outcomes. Secondary outcomes included adverse events and death mortality. Results. A total of 3479 patients were included in this analysis. Compared with the control group, the recanalization rate in the anticoagulant therapy group was increased P < 0.00001 in patients with cirrhosis and portal vein thrombosis without increasing adverse events. Multiple use of enoxaparin in small doses is safer than single large doses P = 0.004 . Direct oral anticoagulants are more effective P < 0.00001 and safer than traditional anticoagulants. Prophylactic anticoagulant therapy can effectively prevent portal vein thrombosis formation P < 0.00001 . Conclusions. Anticoagulation therapy can treat or prevent portal vein thrombosis in patients with liver cirrhosis and is a relatively safe treatment.

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

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818793561 ◽

2018 ◽

Vol 11 ◽

pp. 175628481879356 ◽

Cited By ~ 11

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.

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Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

Case Reports in Radiology ◽

10.1155/2017/2167364 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

F. Chegai ◽

A. U. Cavallo ◽

M. Forcina ◽

V. Giuricin ◽

F. Castellani ◽

...

Keyword(s):

Portal Vein ◽

Autoimmune Hepatitis ◽

Portal Vein Thrombosis ◽

Overlap Syndrome ◽

Splenorenal Shunt ◽

Maximum Diameter ◽

Primary Biliary Cholangitis ◽

Vein Thrombosis ◽

History Of ◽

The Impact

We present a case of giant Splenorenal Shunt (SRS) associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident. SRS was located among the spleen hilum and the left kidney with a maximum diameter of 3.25 cm and was associated with dilatation of left renal vein and inferior vena cava. After a multidisciplinary evaluation the patient was put on the Regional Liver Transplant waiting list and liver transplantation was performed successfully. Although portal vein thrombosis and SRS are common occurrences in cirrhotic patients, the impact in the natural history of the disease is still unclear. Careful management and accurate imaging protocols are essential in the evaluation of those patients.

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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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Prevalence of ADHD in children born by mothers consuming Frankincense during pregnancy

Advances in Pharmacology and Therapeutics Journal ◽

10.18502/aptj.v1i1.7959 ◽

2021 ◽

Author(s):

Alimohammad Ranjbar ◽

Elahe Kamali Ardakani ◽

Rahele Zareshahi

Keyword(s):

Data Gathering ◽

Control Group ◽

Case Group ◽

Dsm V ◽

History Of ◽

The Difference ◽

The Impact ◽

The Relationship ◽

The Brain ◽

Positive Effect

Aims: In Iranian culture, due to some narratives from the prophet Mohammad about the use of frankincense during pregnancy for increasing IQ in children, some women consume frankincense during expectancy. This study's goal is to evaluate the relationship between frankincense used during pregnancy and the incidence of ADHD. Methods: In this study, the case group comprised children 4-17 years old referring to Shahid Chamran Pharmacy in Yazd from summer to winter 2018 for receiving Methylphenidate, those with whom a psychologist had identified ADHD based on DSM-V factors. The control group included children of the same age group but without ADHD. For data gathering, a checklist was used with some questions on smoking, family history of ADHD, presence/absence of a specific disease during pregnancy, frankincense used during pregnancy, and a chemical medication consumed during pregnancy. Results: The main result demonstrated that the children whose mothers used frankincense during pregnancy were 0.67 times less likely to be affected by ADHD than those whose mothers did not use this substance. However, the difference failed to be statistically significant (P>0.05). Conclusion: Some studies report that frankincense can bear a positive effect on the development of the brain and possibly adequate formation of dendrites trees, axons and induce proper communication between them, so the impact of frankincense on the brain may be justified by its protective effect against the hyperactive child.

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Inherited thrombophilic abnormalities and risk of portal vein thrombosis

Thrombosis and Haemostasis ◽

10.1160/th07-08-0526 ◽

2008 ◽

Vol 99 (04) ◽

pp. 675-682 ◽

Cited By ~ 57

Author(s):

Matteo Galli ◽

Monica Gianni ◽

Walter Ageno ◽

Francesco Dentali

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Western Europe ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Vein Thrombosis ◽

Statistical Heterogeneity ◽

Fixed And Random Effects ◽

Study Characteristics ◽

History Of

SummaryInherited thrombophilic abnormalities may have a role in the development of portal vein thrombosis (PVT).However, the prevalence of these factors in patients with PVT has been evaluated only in small studies with non-conclusive results. It was the purpose of this study to assess the risk of PVT associated with factorV Leiden (FVL) and G20210A prothrombin mutation (PTM). The MEDLINE, EMBASE, Cochrane Library databases, reference lists of retrieved articles and contact with content experts were used. Studies carried out in Western Europe comparing the prevalence of prothrombotic abnormalities in patients with PVT and in controls without a history of thromboembolic disease were included. Two reviewers independently selected studies and extracted study characteristics, quality and outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each trial and pooled using a fixed and random-effects model. Statistical heterogeneity was evaluated using the I2 statistic. Sensitivity analyses were performed examining separately studies according to the etiology of PVT and to control population. Twelve studies involving more than 3,000 patients were included. The pooled OR for PVT was 1.90 (95%CI: 1.25, 2.90) in patients with FVL and 4.48 (95%CI: 3.10, 6.48) in patients with PTM. In conclusion, PVT is associated with the presence of FVL and PTM in Western Europe.

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Dynamic 4D-CT Angiography for Guiding Transarterial Chemoembolization: Impact on the Reduction of Contrast Material, Operator Radiation Exposure, Catheter Consumption, and Diagnostic Confidence

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0595-7964 ◽

2018 ◽

Vol 190 (06) ◽

pp. 513-520

Author(s):

Moritz Albrecht ◽

Thomas Vogl ◽

Julian Wichmann ◽

Simon Martin ◽

Jan-Erik Scholtz ◽

...

Keyword(s):

Portal Vein ◽

Contrast Media ◽

Radiation Exposure ◽

Portal Vein Thrombosis ◽

Ct Angiography ◽

Transarterial Chemoembolization ◽

Contrast Material ◽

Diagnostic Confidence ◽

Vein Thrombosis ◽

The Impact

Purpose This study was carried out to investigate the impact of abdominal dynamic four-dimensional CT angiography (4D-CTA) for guiding transarterial chemoembolization (TACE) on the amount of contrast material used, operator radiation exposure, catheter consumption, and diagnostic confidence. Materials and Methods Written consent was waived for this IRB-approved retrospective study. 29 patients (20 men; mean age: 65.7 ± 11.5 years) with malignant liver lesions underwent 4D-CTA, prior to initial TACE. Time-resolved volume-rendering technique (VRT), maximum-intensity projection (MIP), and multiplanar reconstruction (MPR) series were reconstructed, enabling a direct selective catheterization of the tumor-supplying artery without prior conventional digital subtraction angiography (DSA). 29 patients (16 men; mean age: 69.4 ± 13.9) who underwent traditional TACE served as the control group. The amount of administered contrast media, operator radiation exposure, and catheter consumption during TACE were compared. Two radiologists assessed diagnostic confidence in the exclusion of portal vein thrombosis. Results 4D-CTA TACE resulted in a significant reduction in the amount of contrast media used, compared to traditional TACE (–61.0 ml/ –66.3 % intra-arterial, –12.8 ml/ –13.8 % overall; P < 0.001). The dose-area product indicating operator radiation exposure during intervention was reduced by 50.5 % (P < 0.001), and 0.7 fewer catheters on average were used (P = 0.063), while 4D-CTA data was available to guide TACE. Diagnostic confidence in the exclusion of portal vein thrombosis was significantly enhanced by 4D-CTA, compared to traditional DSA images (scores, 3.9 and 2.4, respectively; P < 0.001). Conclusion Dynamic 4D-CTA enables TACE with a substantially reduced amount of contrast material, decreases operator radiation exposure, and increases diagnostic confidence in the exclusion of portal vein thrombosis. Key points Citation Format

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