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2016, Number 6

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Ann Hepatol 2016; 15 (6)

Portal vein thrombosis in patients with cirrhosis: just a common finding or a predictor of poor outcome?

Borjas-Almaguer OD, Cortez-Hernández CA, González-Moreno EI, Bosques-Padilla FJ, González-González JA, Garza AA, Martínez-Segura JA, García-Compean D, Alejandre-Loya JV, García-García J, Delgado-García G, Maldonado-Garza HJ

Language: English
References: 25
Page: 902-906
PDF size: 138.79 Kb.


ABSTRACT

Background & Aims. It is unclear whether portal vein thrombosis (PVT) unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis. The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence. Material and methods. Retrospective search in one center from June 2011 to December 2014. Results. 169 patients, 55 women and 114 men, median age 54 (19-90) years. Thirteen had PVT (7.6%). None of the patients received anticoagulant treatment. The PVT group was younger (49 [25-62] vs. 55 [19-90] years p = 0.025). Child A patients were more frequent in PVT and Child C in Non-PVT. Median Model for End Stage Liver Disease (MELD) score was lower in PVT (12 [8-21] vs. 19 [7-51] p ≤ 0.001) p ≤ 0.001). There was no difference between upper gastrointestinal bleeding and spontaneous bacterial peritonitis in the groups. Encephalopathy grade 3-4 (4 [30.8%] vs. 73 [46.8%] p = 0,007) and large volume ascites (5 [38.5%] vs. 89 [57.1%] p= 0,012) was more common in non-PVT. Survival was better for PVT (16.5 ± 27.9 vs. 4.13 ± 12.2 months p = 0.005). Conclusions: We found that PVT itself does not lead to a worse prognosis. The most reliable predictor for clinical outcome remains the MELD score. The presence of PVT could be just an epiphenomenon and not a marker of advanced cirrhosis.


REFERENCES

  1. Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, Volk ML. The Epidemiology of Cirrhosis in the United States: A Population-based Study. J Clin Gastroenterol 2015; 49: 690-6.

  2. SINAS. Mortalidad. Información tabular. Available from: http://sinais.salud.gob.mx/mortalidad/: 2008; 2008 [updated 2011; cited 2015 03/05/2015].

  3. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-51.

  4. Valla DC, Rautou PE. The coagulation system in patients with end-stage liver disease. Liver Int 2015; 35(Suppl. 1): 139-44.

  5. Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology 1992; 16: 1195-8.

  6. Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006; 12: 2115-9.

  7. Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, Grandone E, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40: 736-41.

  8. John BV, Konjeti R, Aggarwal A, Lopez R, Atreja A, Miller C, Zein NN, et al. Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis. Ann Hepatol 2013; 12: 952-8.

  9. Berry K, Taylor J, Liou IW, Ioannou GN. Portal vein thrombosis is not associated with increased mortality among patients with cirrhosis. Clin Gastroenterol Hepatol 2015; 13: 585-93.

  10. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426-37, 37 e1-9.

  11. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014; 383:1749-61.

  12. Raja K, Jacob M, Asthana S. Portal vein thrombosis in cirrhosis. J Clin Exp Hepatol 2014; 4: 320-31.

  13. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl 2010; 16: 999-1005.

  14. Ponziani FR, Zocco MA, Senzolo M, Pompili M, Gasbarrini A, Avolio AW. Portal vein thrombosis and liver transplantation: implications for waiting list period, surgical approach, early and late follow-up. Transplant Rev 2014; 28: 92-101.

  15. Girleanu I, Stanciu C, Cojocariu C, Boiculese L, Singeap AM, Trifan A. Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients. Saudi J Gastroenterol 2014; 20: 288-92.

  16. Chung JW, Kim GH, Lee JH, Ok KS, Jang ES, Jeong SH, Kim JW. Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis. Clin Mol Hepatol 2014; 20: 384-91.

  17. Gabr MA, Bessa SS, El-Zamarani EA. Portal vein thrombosis in Egyptian patients with liver cirrhosis: Role of methylenetetrahydrofolate reductase C677T gene mutation. Hepatol Res 2010; 40: 486-93.

  18. Gonzalez-Gonzalez JA, Garcia-Compean D, Vazquez- Elizondo G, Garza-Galindo A, Jaquez-Quintana JO, Maldonado- Garza H. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Ann Hepatol 2011; 10: 287-95.

  19. Roman S, Zepeda-Carrillo EA, Moreno-Luna LE, Panduro A. Alcoholism and liver disease in Mexico: genetic and environmental factors. World J Gastroenterol 2013; 19: 7972-82.

  20. Luca A, Caruso S, Milazzo M, Marrone G, Mamone G, Crino F, Maruzzelli L, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 2012; 265: 124-32.

  21. Farmer AD, Saadeddin A, Holt CE, Bateman JM, Ahmed M, Syn WK. Portal vein thrombosis in the district general hospital: management and clinical outcomes. Eur J Gastroenterol Hepatol 2009; 21: 517-21.

  22. Eleftheriadis N, Makris P. Portal vein thrombosis in a patient with HCV cirrhosis and combined hemophilia A and thrombophilia V Leiden. Ther Clin Risk Manag 2010; 6: 539-41.

  23. Delgado MG, Seijo S, Yepes I, Achecar L, Catalina MV, Garcia- Criado A, Missing author, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776-83.

  24. Minguez B, Garcia-Pagan JC, Bosch J, Turnes J, Alonso J, Rovira A, Córdoba J. Noncirrhotic portal vein thrombosis exhibits neuropsychological and MR changes consistent with minimal hepatic encephalopathy. Hepatology 2006; 43: 707-14.

  25. Hugenholtz GC, Northup PG, Porte RJ, Lisman T. Is there a rationale for treatment of chronic liver disease with antithrombotic therapy? Blood Rev 2015; 29: 127-36.




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