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18.06.2018 | original article | Ausgabe 13-14/2018 Open Access

Wiener klinische Wochenschrift 13-14/2018

Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 13-14/2018
Autoren:
Bernhard Scheiner, Paul René Stammet, Sebastian Pokorny, Theresa Bucsics, Philipp Schwabl, Andrea Brichta, Johannes Thaler, Katharina Lampichler, Ahmed Ba-Ssalamah, Cihan Ay, Arnulf Ferlitsch, Michael Trauner, Mattias Mandorfer, Thomas Reiberger
Wichtige Hinweise

Authors contributions

Concept of the study (T. Reiberger; B. Scheiner; P. R. Stammet; S. Pokorny; J. Thaler; C. Ay; M. Mandorfer), extraction of data (P. R. Stammet; S. Pokorny; A. Brichta), writing of the manuscript (B. Scheiner; T. Reiberger; P. R. Stammet; S. Pokorny; M. Mandorfer), revision for important intellectual content (all authors), drafting of the manuscript (B. Scheiner; T. Reiberger; M. Mandorfer)

Summary

Background

Non-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis.

Aim

We retrospectively assessed the course of non-malignant PVT in patients receiving AC.

Methods

Parameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented.

Results

Among 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (≥9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; p = 0.08) and lower progression rates of 25% (vs. 42% without AC; p = 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (n = 39), long-term AC (n = 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, p = 0.031). Interestingly, AST/ALT tended to decrease (−19%/−16%) and the proportion of patients with ascites became lower (−33%) with long-term AC (without AC: ±0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6 g/dl) when compared to patients without long-term AC (−2%/−0.8 g/dl; p = 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%).

Conclusion

Our findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.
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