Predicting early mortality in patients with cirrhosis of the liver

Abstract

Aim: To determine the natural history of acute portal venous thrombosis (PVT) and acute mesenteric venous thrombosis (MVT) with specific reference to mortality and the development of portal hypertension. Methods: Retrospective analysis of patients who fulfilled criteria for acute PVT or acute MVT. Patients had symptoms of abdominal pain of less than 6 weeks' duration, and thrombosis was confirmed on ultrasonography, computerized tomography, angiography, or surgery. When information was unavailable, a questionnaire was mailed to the patients for follow-up. Special coagulation tests were carried out at the initial admission and specific etiologies predisposing to thrombophilia investigated. Patients were advised long-term anticoagulation. Results: Eighty-six patients fulfilled criteria for acute portal or acute mesenteric venous thrombosis. A specific etiology (malignancy, hematological disease, inflammatory bowel disease, or surgery) was found in 47 of the patients. The remaining 39 patients were classified as idiopathic thrombosis. There was no difference in gender, age, clinical presentation, radiological findings, or time to diagnosis between the two groups. Three patients in each group had recurrent thrombosis. No patient of isolated mesenteric venous thrombosis either extended the thrombus into the portal vein or had variceal bleeding on long-term follow-up. Significant differences in presentation, as well as in follow-up between the two groups are given in the table. Conclusions: Patients with idiopathic acute mesenteric or portal vein thrombosis have a more favorable short-term, as well as long-term prognosis. 1056