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Abstract
Background The prevalence of Portal Vein Thrombosis (PVT) is highly variable at different stages of liver disease: in compensated patients 10%, in decompensated patients 17%, in acute decompensated cirrhosis 9%, and in post-liver transplantation patients 2-26%. Aim The aim of the study was to assess the efficacy and safety of systemic thrombolysis in acute portal vein thrombosis in patients with liver cirrhosis. Methods A total of 10 compensated cirrhotic patients with acute portal vein thrombosis were examined by abdominal ultrasonography with color Doppler and Contrast-enhanced computerized tomography. Continuous intravenous infusion of recombinant tissue plasminogen activator(r-tPA.) and Low molecular weight heparin (LMWH) was used to treat all patients for a maximum of 7 days. Patients were followed up for improvement of clinical symptoms and radiological by abdominal ultrasound with color Doppler and contrast-enhanced computerized tomography. Results The regimen of therapy was found to be well-tolerated by all the patients. At the end of the seven days, six patients (60%) had full recanalization of the portal vein, while three had partial recanalization (30%) and no recanalization in only one patient (10%). Conclusion The preliminary data indicate that systemic thrombolytic therapy combined with low molecular weight heparin for the treatment of PVT appears to be safe and effective over a few days with no clinically significant side effects.
Highlights
Portal Vein Thrombosis (PVT) is described as partial or total obstruction of the main portal trunk by a thrombus, which might potentially include the right and / /left intrahepatic portal branches
Plan of therapy: In cases of acute PVT presenting with pictures of the superior mesenteric vein occlusion with edema in the bowel wall with the potential risk of developing subsequent mesenteric arterial occlusion, systemic thrombolysis was immediately started in combination with low molecular weight heparin
Fifteen patients with an acute PVT in cirrhotic patients were recruited for the study; five were excluded, three because of hepatocellular carcinoma (HCC), and 2 because of a recent splenectomy
Summary
Portal Vein Thrombosis (PVT) is described as partial or total obstruction of the main portal trunk by a thrombus, which might potentially include the right and / /left intrahepatic portal branches. PVT can spread to the mesenteric vein (MV) and splenic vein, resulting in portal venous thrombosis. This is not a widely recognised criterion, certain authors consider PVT to be acute if symptoms appear within 60 days after diagnosis [1, 2]. Adriano De Santis and colleagues showed that thrombolytic treatment of acute PVT in patients with cirrhosis with intravenous recombinant tissue plasminogen activator (r-tPA.) and Low molecular weight heparin (LMWH). It seems to be safe and effective, and it can greatly lower esophageal varices pressure [10]. The prevalence of Portal Vein Thrombosis (PVT) is highly variable at different stages of liver disease: in compensated patients 10%, in decompensated patients 17%, in acute decompensated cirrhosis 9%, and in postliver transplantation patients 2-26%
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