Original article
Liver, pancreas, and biliary tract
Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis

https://doi.org/10.1016/j.cgh.2012.01.012Get rights and content

Background & Aims

Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there are limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT.

Methods

We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n = 31) or progression of previously known PVT (n = 24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed, and recanalization was evaluated by using Doppler ultrasound, angio–computed tomography, and/or angio–magnetic resonance imaging analyses.

Results

Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed less frequent liver-related events (portal hypertension–related bleeding, ascites, or hepatic encephalopathy) during the follow-up period, but this difference was not statistically significant (P = .1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50 × 109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy.

Conclusions

Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis.

Section snippets

Patients

Patients with cirrhosis and acute/subacute thrombosis or progression of previous thrombosis of the splenoportomesenteric axis attended from June 2003 to September 2010 in 4 tertiary hospitals in Spain (Hospital Clinic, Barcelona; Hospital Ramón y Cajal, Madrid; Hospital General Universitario Gregorio Marañón, Madrid; Hospital Marqués de Valdecilla, Santander) and who received treatment with anticoagulants were included in the study. The decision to start anticoagulation treatment followed the

Patient Characteristics and Extent of Thrombosis at Diagnosis

Fifty-five patients were included and followed up for a median of 19 months (range, 1–68 months) after time zero. The main characteristics at time zero are presented in Table 1. Only 1 patient had a history of thrombosis (a pulmonary embolism).

Diagnosis and extension of thrombosis at time zero were based on data obtained from 1 imaging study of 38 patients (69%), angio-CT scan in 21 patients (38%), angio-MRI in 3 patients (6%), and Doppler ultrasound in 14 patients (25%). Two or more imaging

Discussion

The belief that patients with cirrhosis have a hypocoagulable state has recently been challenged.16, 17, 18, 19, 20 Indeed, the decrease in liver-derived procoagulant factors is usually overcompensated by a decrease in liver-derived anticoagulant factors and by an increase in the procoagulant factors VIII and von Willebrand. Consequently, patients with cirrhosis, especially in Child–Pugh class C,17 present a hypercoagulable rather than hypocoagulable state. Supporting this observation, patients

Acknowledgements

Drs Delgado and Seijo contributed equally to this work.

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported in part by grants from the Ministerio de Educación y Ciencia (SAF-10/17043) and from the Instituto de Salud Carlos III (PI 09/01261). CIBEREHD is funded by the Instituto de Salud Carlos III. M.G.D. has received financial support from the Fundación Banco Bilbao Vizcaya Argentaria. S.S. is supported by Rio Hortega-Instituto de Salud Carlos III.

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