Abstract
SummaryBackgroundNon-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.AimWe retrospectively assessed the course of non-malignant PVT in patients receiving AC.MethodsParameters 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.ResultsAmong 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%).ConclusionOur 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.
Highlights
Cirrhosis can develop from virtually all forms of chronic liver disease with alcoholic liver disease and chronic viral hepatitis being the most common etiologies in developed countries [1]
The prevalence of portal vein thrombosis (PVT) is up to 23.3% in liver transplantation candidates without hepatocellular carcinoma (HCC) and the yearly incidence of non-malignant PVT is estimated to be between 7–11% in patients with cirrhosis
We identified a total of 122 patients diagnosed with PVT at our center, whereby 71 patients had to be excluded due to underlying malignancies
Summary
Cirrhosis can develop from virtually all forms of chronic liver disease with alcoholic liver disease and chronic viral hepatitis being the most common etiologies in developed countries [1]. In contrast to the dogma of auto-anticoagulation in cirrhosis, venous thrombosis is more common in patients with cirrhosis than in the general population [4, 5]. There is a 7.3-fold increased risk of developing portal vein thrombosis (PVT) with cirrhosis. This represents a severe complication in patients with liver cirrhosis that may lead to intestinal infarction and preclude the option for orthotopic liver transplantation [6, 7]. The prevalence of PVT is up to 23.3% in liver transplantation candidates without hepatocellular carcinoma (HCC) and the yearly incidence of non-malignant PVT is estimated to be between 7–11% in patients with cirrhosis
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