Abstract
BackgroundPortal vein thrombosis (PVT) is a common complication of cirrhosis. However, in patients with PVT and cirrhosis, there is no clear evidence supporting effective treatment modalities. In this study, we examined the effectiveness and safety of anticoagulation therapy using danaparoid sodium for PVT in patients with cirrhosis.MethodsThis retrospective study assessed 52 cirrhotic patients with PVT treated with danaparoid sodium for 2 weeks between November 2008 and September 2018. The primary outcome measure was the post-treatment status of PVT assessed by reduction in thrombus volume and safety of the therapeutic intervention. PVT status was evaluated with contrast-enhanced computed tomography (CECT). All patients received 1250 units of danaparoid sodium twice daily by intravenous injection for 14 days. Patients on antithrombin III (AT-III) combination therapy were additionally administered 1500 units of AT-III on days 1–5 and days 8–12. Effectiveness was evaluated by CECT from between days 13 and 18. The secondary outcome measure was the prognosis of PVT.ResultsAll patients showed reduction in PVT volume without complications. Return of plasma AT-III level to > 70% during the treatment period contributes to ≥75% reduction of PVT volume. The prognosis in PVT patients depends on hepatic reserve capacity. When limited to Child-Pugh B and C liver cirrhosis patients, a ≥ 75% reduction of PVT volume improved the prognosis.ConclusionsDanaparoid sodium-based anticoagulation therapy was effective and safe for PVT in patients with cirrhosis. Return of plasma AT-III level to the normal range during the treatment period contributes to reduction of PVT volume. A reduction of ≥75% in PVT volume may improve the prognosis of Child-Pugh B and C decompensated cirrhosis patients with PVT.
Highlights
Portal vein thrombosis (PVT) is a common complication of cirrhosis
In Child-Pugh A compensated cirrhosis patients, the effects of treatment of PVT (P = 0.0589, Fig. 5f) and the presence of hepatocellular carcinoma (HCC) (P = 0.3189, Fig. 5g) did not affect prognosis. These results suggested the possibility that a ≥ 75% reduction of PVT volume may improve prognosis in ChildPugh B and C decompensated cirrhosis patients with PVT, and danaparoid sodium-based anticoagulation therapy should be considered for such patients
This study demonstrated that all the patients who received danaparoid sodium-based anticoagulation therapy showed reduction of PVT volume
Summary
Portal vein thrombosis (PVT) is a common complication of cirrhosis. In patients with PVT and cirrhosis, there is no clear evidence supporting effective treatment modalities. We examined the effectiveness and safety of anticoagulation therapy using danaparoid sodium for PVT in patients with cirrhosis. Portal vein thrombosis (PVT) is characterized by thrombus formation in the trunk of the portal vein involving its right and left intrahepatic branches. The thrombus may even extend to the splenic or superior mesenteric vein or toward the liver involving the intrahepatic portal branches [1]. In patients with PVT and cirrhosis, no evidence supports the use of anticoagulation therapy because of the risk of bleeding due to reduced synthesis of coagulation factors and high incidence of varices and portal hypertensive gastropathy [1, 2, 7]
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