Faculty Opinions recommendation of Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study.

Abstract Elective laparoscopic splenectomy (LS) is performed with increasing frequency in relation to open splenectomy (OS). The advantage with LS is reduced morbidity. Moreover, this method is feasible also in patients with splenomegaly, a patient group with more postoperative complications as bleeding, infections and portal vein thrombosis. Portal vein thrombosis (PVT) is a rare but serious complication of splenectomy. We retrospectively reviewed the medical records of 69 consecutive patients splenectomized for haematological diseases during a five-years period (Jan 1999 to Dec 2003) at the Dep. of Surgery Huddinge University Hospital, with the aim of comparing the results and complications after LS and OS, with focus on thromboembolic events. The follow-up for all patients was performed Jan 31. 2004. Thirty-nine patients underwent LS and 30 OS. There were three conversions (7.7%) from laparoscopic to open surgery due to bleeding and splenomegaly. Accessory spleens were found in 16 of 69 (23%) patients, 6 of 39 (15%) in LS and 10 of 30 (33%) in OS. Thromboembolic complications were seen in seven patients; a) deep vein thromboses in the lower leg in two patients with ITP, both with LS and neither had received thromboprophylaxis, b) PVT in five patients, one after LS and four after OS; three with CLL, (two with a concomitant haemolytic anaemia) and two with a myeloproliferative disease. The five patients with PVT had all splenomegaly and had received thromboprophylaxis with low-molecular-weight heparin. PVT was diagnosed from day 6 to day 111 after splenectomy. Three of the five patients had thrombocytosis, 478, 740 and 1459x 10(9) at the time of PVT-diagnosis. In all the splenectomized patients, two patients had overwhelming post splenectomy sepsis (OPSI). One patient with Evans syndrom died of E. coli sepsis four months after splenectomy and one patient with myelofibrosis had severe pneumococksepsis 44 months after splenectomy. Both had recieved preoperative pneumocock vaccination. Further seven patients died during the follow-up period, five due to infections and bleedings, in all related to progressive malignant lymphoma. One patient died of sudden cardiac arrest 15 months postoperative, and one patient performed suicide. Conclusions: Portal vein thrombosis after splenectomy was seen in 13.5 % of patients with haematological malignancies despite thromboprophylaxis. Patients with splenomegaly and myeloproliferative disease or CLL with haemolytic anaemia have high risk of PVT. We recommend careful observation of postoperative thrombocytosis and extended thromboprophylaxis. Ultrasonography or CT should be considered in all patients with abdominal symtoms after splenectomy. Patients should receive pneumocockvaccination and be informed of the lifelong risk of severe infections.

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Long-term follow-up of patients with portal vein thrombosis and myeloproliferative neoplasms

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2011.04484.x ◽

2011 ◽

Vol 9 (11) ◽

pp. 2208-2214 ◽

Cited By ~ 45

Author(s):

J. HOEKSTRA ◽

E. L. BRESSER ◽

J. H. SMALBERG ◽

M. C. W. SPAANDER ◽

F. W. G. LEEBEEK ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Myeloproliferative Neoplasms ◽

Vein Thrombosis ◽

Long Term Follow Up

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P1273 : Acute portal vein thrombosis: Clinical features, diagnosis and outcomes after 5 years of follow-up

Journal of Hepatology ◽

10.1016/s0168-8278(15)31468-9 ◽

2015 ◽

Vol 62 ◽

pp. S836

Author(s):

A. Peixoto ◽

M. Silva ◽

P. Pereira ◽

G. Macedo

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Clinical Features ◽

Vein Thrombosis

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PORTAL VEIN THROMBOSIS AND LIVER TRANSPLANTATION - LONG TERM FOLLOW UP

Transplantation Journal ◽

10.1097/00007890-201007272-01648 ◽

2010 ◽

Vol 90 ◽

pp. 844

Author(s):

A. P. Ramos ◽

C. P.H. Reigada ◽

E. C. Ataide ◽

A. R. Cardoso ◽

C. A. Caruy ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Vein Thrombosis ◽

Long Term Follow Up

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Exploring the Outcomes of Portal Vein Thrombosis in the Clinical Setting of Cirrhosis, Malignancy, and Intra-abdominal Infections with and without Anticoagulation: A Retrospective 5-Year Study

International Journal of Angiology ◽

10.1055/s-0037-1607049 ◽

2017 ◽

Vol 27 (04) ◽

pp. 208-212

Author(s):

Joanne Joseph ◽

Samuel Chew ◽

Julie George ◽

Tay Chin ◽

Ashish Sule

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Complete Resolution ◽

Vein Thrombosis ◽

Risk Of Bleeding ◽

Partial Resolution ◽

Outcomes Measures ◽

Increased Risk ◽

Abdominal Infections

AbstractThe aim of this study was to understand the differences in clinical outcomes in portal vein thrombosis (PVT) patients with cirrhosis, malignancy, and abdominal infections, with or without anticoagulation. This study was approved by ethics committee. Data were collected from 2011 to 2016. Patients were classified into three groups: PVT with cirrhosis, malignancy, and infections. Primary outcomes measures collected were clot resolution, bleeding, recurrence, and death. Frequency, means, and percentages were calculated. In total, 30 patients were analyzed in this study. Mean age was 60.8 years (range of 30–91 years). There were 19 (63.3%) males and 11 (36.7%) females with ethnicity: 21 (70.0%) Chinese, 2 (6.7%) Malay, 2 (6.7%) Indian, and 5 (16.7%) other race. Fifteen patients received anticoagulation and 15 did not receive anticoagulation. Of the 15 patients who received anticoagulation, there was complete resolution of thrombus in 5 (33.3%), partial resolution in 1 (6.7%), and no resolution in 9 (60.0%). Of these 15 patients, there was bleeding in 3 (20.0%), there was no recurrence in 9 (60.0%), and 3 (20.0%) died during the period of follow-up. Of the 15 patients who did not receive anticoagulation, there was complete resolution of thrombus in 2 (13.3%), partial resolution in 0 (0.0%), and no resolution in 13 (86.7%). Of these 15 patients, there was bleeding in 0 (0%), there was recurrence in 2 (13.3%), and 6 (40.0%) died during the period of follow-up. Anticoagulation is effective in PVT. It reduces mortality with lower rate of recurrence. However, it is associated with increased risk of bleeding.

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Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS Versus Anticoagulation Versus No Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10112316 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2316

Author(s):

Chenyang Zhan ◽

Vinay Prabhu ◽

Stella K. Kang ◽

Clayton Li ◽

Yuli Zhu ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Liver Function Tests ◽

Bleeding Complications ◽

Imaging Data ◽

Vein Thrombosis ◽

Intrahepatic Portosystemic Shunt ◽

Cirrhotic Patients ◽

Anticoagulated Patients

Background: There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. Methods: This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6–9 months) and late follow-up (9–16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. Results: The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up (p = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up (p = 0.007). No bleeding complications attributable to anticoagulation were observed. Conclusion: TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.

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The Impact of Portal Vein Thrombosis on the Prognosis of Patients With Cirrhosis: A Retrospective Propensity-Score Matched Study

Frontiers in Medicine ◽

10.3389/fmed.2021.685944 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhiji Chen ◽

Tao Ran ◽

Haiyan Cao ◽

Feng Xu ◽

Zhi-hang Zhou ◽

...

Keyword(s):

Propensity Score ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Serum Sodium Level ◽

Meld Score ◽

Group 14 ◽

Vein Thrombosis ◽

Matched Study ◽

The Impact

Objectives: To investigate the impact of portal vein thrombosis (PVT) on cirrhosis decompensation and survival of cirrhosis.Methods: In this retrospective observational study between January 2012 and August 2020, 117 patients with cirrhotic PVT and 125 patients with cirrhosis were included. Propensity score matching (PSM) was applied to reduce the bias. The clinical characteristics of non-tumoral PVT in cirrhosis and its influence on cirrhosis decompensation and survival were analyzed.Results: The median follow-up for the PVT group was 15 (8.0–23.0) months and for the non-thrombosis group 14 (8.0–23.5) months. The presence of PVT was related with esophageal varices, higher Child-Pugh score and MELD score (P < 0.05). Most PVTs were partial (106/117). Non-occlusive PVT disappeared on later examinations in 32/106 patients (30.19%), of which six patients reappeared. All the 11 patients with occlusive PVT remained occlusive, among which five patients (45.45%) developed portal cavernoma. There was no significant correlation between PVT and decompensation or survival before or after PSM. Multivariate analysis identified only Child-Pugh score (HR = 2.210, 95% CI: 1.332–3.667) and serum sodium level (HR = 0.818, 95% CI: 0.717–0.933) as independent factors for death.Conclusion: Though PVT is associated with greater Child-Pugh score and MELD score, it has no significant impact on the progression of cirrhosis.

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