Portal Vein Thrombosis In Cirrhotic Patients Research Articles

Comparative effectiveness of warfarin in cirrhotic patients with non-symptomatic portal vein thrombosis: a multicenter, randomized controlled trial

ABSTRACT The effectiveness and risks of anticoagulant therapy in cirrhotic patients with non-symptomatic portal vein thrombosis (PVT) remain unclear. We conducted a multicenter, Zelen-designed randomized controlled trial to determine the effectiveness of warfarin in cirrhotic patients with non-symptomatic PVT during a one-year follow-up. In brief, 64 patients were 1:1 randomly divided into the anticoagulation group or the untreated group. The probability of recanalization was significantly higher in the anticoagulation group than those untreated in both ITT analysis (71.9% vs 34.4%, p = 0.004) and PP analysis (76.7% vs 32.4%, p < 0.001). Anticoagulation treatment was the independent predictor of recanalization (HR 2.776, 95%CI 1.307–5.893, p = 0.008). The risk of bleeding events and mortality were not significantly different. A significantly higher incidence of ascites aggravation was observed in the untreated group (3.3% vs 26.5%, p = 0.015). In conclusion, warfarin was proved to be an effective and safe as an anticoagulation therapy for treating non-symptomatic PVT in cirrhotic patients.

Variations in Practice Among Cirrhotic Patients With Portal Vein Thrombosis and Esophageal Varices: A North American Survey Study.

There exists variation regarding the approach to anticoagulation and variceal hemorrhage (VH) prophylaxis among patients with cirrhosis and portal vein thrombosis (PVT). A survey was distributed to gastroenterology and hepatology providers to assess the approach to anticoagulation and VH prophylaxis among patients with PVT in cirrhotic patients. Providers were more likely to start anticoagulation if the patient was listed for liver transplantation, was symptomatic, or had superior mesenteric vein thrombosis. For prevention of first VH, many providers opt for combination therapy with both nonselective beta blockers and variceal ligation. Although providers agree on the clinical scenarios that merit initiation of anticoagulation, practice variation was identified in the means of preventing first VH.

Bacterial infections as a risk factor for non-neoplastic portal vein thrombosis development in cirrhotic patients.

Portal vein thrombosis (PVT) and sepsis are common complications in patients with liver cirrhosis. Factors that lead to PVT are not completely understood. This study aimed to investigate the possible association between bacterial infections and the development of PVT in cirrhotic patients. 202 consecutive cirrhotic patients without previous infections, followed at the Liver Unit in Verona Hospital, were enrolled from 2017 to 2021 (median follow-up 3.3 years). During the follow-up period, PVT was diagnosed by ultrasound, CT and/or MRI, and episodes of bacterial infections requiring hospitalization were recorded. Malignant PVT was an exclusion criterion. Of the 202 patients enrolled (68.3% males, mean age 63.8±11 years), 22 (10.8%) developed PVT during the follow up. In patients with PVT, the prevalence of previous bacterial infections was significantly higher compared to patients without PVT (63.6% vs 31.1%; p=0.02). Cox regression analysis revealed that a history of bacterial infection was the only variable that demonstrated a significant association with the risk of de novo PVT occurrence (HR 4.04, 95% CI: 1.68-9.65). in patients with liver cirrhosis bacterial infections are a predisposing factor for the following development of PVT. Further studies are needed to confirm this evidence.

No Differences in Rotational Thromboelastometry Measurements between Portal and Peripheral Circulation in Cirrhotic Patients Undergoing TIPS

In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) is considered a standardized treatment of refractory ascites or variceal bleeding. TIPS thrombosis (TT) and/or portal vein thrombosis (PVT) are possible complications during/after TIPS placement. Previous studies suggested increased clotting activity in portal circulation (PORC). This pilot study aimed to evaluate alterations and differences of coagulation function in PORC and in peripheral circulation (PERC) via rotational thromboelastometry during TIPS. Blood samples were collected from cirrhotic patients (n = 13; median Model of End Stage Liver Disease, MELD Score: 12; median age: 60 years) undergoing TIPS (10/13 TIPSs were elective procedures due to refractory ascites) as follows: median cubital vein (MCV; PERC)-confluence of the three hepatic veins to the inferior cava vein (HV/ICV; PORC)-portal vein (PV; PORC)-TIPS (PORC). This research utilized four variables of the extrinsic test EXTEM, i.e., clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and maximum lysis (ML). EXTEM results [mean, M (range) ± standard deviation, SD (range)] showed no significant differences for CT [M (70-73) ± SD (9-13); p = 0.93] or CFT [M (137-155) ± SD (75-112); p = 0.97] or MCF [M (51-54) ± SD (9-10); p = 0.90] or ML [M (9-10) ± SD (4-5); p = 0.89] between the compartments, i.e., MCV vs. HV/ICV vs. PV vs. TIPS. Overall, we detected no differences in coagulation function between PERC and PORC. These results are in contrast to previous reports suggesting increased clotting activity in PORC vs. PERC in association with liver cirrhosis. Rotational thromboelastometry-based evaluation of coagulation function in PERC appears to reliably reflect coagulation function in PORC with respect to risk estimation for TT and/or PVT in cirrhotic patients undergoing TIPS.

Nomogram for Predicting Portal Vein Thrombosis in Cirrhotic Patients: A Retrospective Cohort Study.

Portal vein thrombosis (PVT) is a common complication in cirrhotic patients and will aggravate portal hypertension, thus leading to a series of severe complications. The aim of this study was to develop a nomogram based on a simple and effective model to predict PVT in cirrhotic patients. Clinical data of 656 cirrhotic patients with or without PVT in the First Affiliated Hospital of Soochow University and The Third Affiliated Hospital of Nantong University from January 2017 to March 2022 were retrospectively collected, and all patients were divided into training, internal and external validation cohorts. SPSS and R software were used to identify the independent risk factors and construct a predictive model. We evaluated the predictive value of the model by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. The feasibility of the model was further validated in the internal and external cohorts. All enrolled patients were followed up to construct the survival curves and calculate the incidence of complications. The predictors of PVT included serum albumin, D-dimer, portal vein diameter, splenectomy, and esophageal and gastric varices. Based on the clinical and imaging findings, the final model served as a potential tool for predicting PVT in cirrhotic patients, with an AUC of 0.806 (0.766 in the internal validation cohort and 0.845 in the external validation cohort). The decision curve analysis revealed that the model had a high level of concordance between different medical centers. There was a significant difference between the PVT and non-PVT groups in survival analyses, with p values of 0.0477 and 0.0319 in the training and internal validation groups, respectively, along with p value of 0.0002 in the external validation group according to log-rank test; meanwhile, the median survival times of the PVT group were 54, 43, and 40 months, respectively. The incidence of recurrent esophageal and gastric variceal bleeding (EGVB) during the follow-up showed significant differences among the three cohorts (p = 0.009, 0.048, and 0.001 in the training, internal validation, and external validation cohorts, respectively). The nomogram based on our model provides a simple and convenient method for predicting PVT in cirrhotic patients. Cirrhotic patients with PVT had a shorter survival time and were prone to recurrent EGVB compared with those in the non-PVT group.

COVID-19 in Cirrhotic Patients: Is Portal Vein Thrombosis a Potential Complication?

Introduction Several studies have demonstrated that thromboembolic events increased in patients with coronavirus infection, usually occurring in elderly patients with severe illness, associated with comorbid diseases such as diabetes and hypertension. Portal vein thrombosis (PVT) is a rare venous thromboembolic disease occurring typically in patients with an underlying disease such as decompensated cirrhosis with or without hepatocellular carcinoma (HCC). Aim To evaluate incidence of occurrence of acute PVT in cirrhotic patients infected with 2019 coronavirus disease (COVID-19). Methods This cross-sectional, observational study involved 70 patients of the liver cirrhosis: (group A) 28 patients with liver cirrhosis infected with COVID-19, and 42 patients with liver cirrhosis as the control group matched for age and sex (group B). All patients were subjected to thorough medical history, routine investigations (complete blood count, liver, and renal function tests), imaging in the form of abdominal and Doppler ultrasonography to assess the presence of acute PVT, serum ferritin, D-dimer, C-reactive protein, and PCR of COVID-19 for group A only. Results There was a significant difference between the two groups regarding Doppler ultrasound findings as 3 of the patients in group A had PVT (10.7%), 2 of them had HCC diagnosed by triphasic CT abdomen, and only 1 patient in group B had PVT (2.3%) (p < 0.05). Conclusion In cirrhotic patients infected with COVID-19, portal vein thrombosis may be a potential complication even in the absence of hepatocellular carcinoma; further prospective studies with longer follow-up may be needed.

Bacterial infection as a predisposing factor for the development of portal vein thrombosis in cirrhotic patients: a prospective study

Background and Aims: Non-malignant portal vein thrombosis (PVT) is one of the complications of liver cirrhosis. The predisposing factors for PVT in cirrhotic patients are not entirely clear. The aim of this study was to identify possible clinical risk factors related to the development of PVT in patients with liver cirrhosis.

The Predictive Role of Variceal Band Ligation in the Development of Portal Vein Thrombosis in Cirrhotic Patients

Abstract Introduction. It is well known that portal vein thrombosis (PVT) can accelerate liver decompensation, reducing overall survival(1). In the literature, the topic whether PVT is a risk factor for variceal bleeding or it influences the effectiveness of variceal band ligation (VBL) remains of great interest The aim of this study was to assess if VBL is a potential risk factor for PVT development. An observational and retrospective study was conducted in a single tertiary center from 2010 to 2021 and included data from 285 patients with liver cirrhosis. Results. Of the 285 patients, gender distribution described 47.32% female (n =135) and 52.8% male (n =150) with a mean age of 55 years (range =23-79). The average MELD score was 12.5 (range 7-27). Of the total number of patients, 48.8% (n=139) had previous VBL: 20% (n=57) underwent primary prophylactic VBL and 34.7% (n=99) underwent secondary prophylaxis. Thus, 285 VBL procedures had been performed and the average number of VBL session was 2 (range 1-10) The mean time follow up was 92.55 months (range 22-230. During the follow up period PVT was diagnosed in 41.4% of patients (n =118) of which 67.77% (n =80) had at least one previous session of VBL: 33% of patients (n =39) had performed primary prophylaxis and 34.74% (n =41) secondary. A logistic regression was conducted to assess if VBL (primary and/or secondary prophylaxis) are risk factors for PVT development. The model was significant for primary prophylaxis (p =0.002, OR 3.28, CI 1.53-7.02) resulting that the risk of PVT is increasing around 3 times after primary prophylactic VBL. Conclusion. Our study showed a certain predisposition for cirrhotic patients to develop PVT after VBL performed as primary prophylaxis thus raising the question: does VBL impact the occurrence of PVT in cirrhotic patients? Furthermore, to our knowledge, this is the first study in the literature that focuses on this topic. More studies should be performed to evaluate and describe the relationship between VBL and the risk of PVT.

PREVALENCE AND CHARACTERISTICS OF PORTAL VEIN RECANALIZATION IN CIRRHOTIC PATIENTS ADMITTED WITH PORTAL THROMBOSIS IN A THIRD LEVEL CARE CENTER

Portal vein thrombosis (PVT) refers to the formation of blood clots within the trunk of the portal vein (PV) or its main branches, which can spread to the superior mesenteric (SMV) and splenic (VE) veins. The natural history of liver cirrhosis is a complication with a "rebalanced" coagulation system that can promote bleeding or a thrombotic tendency. The prevalence in compensated cirrhotic is 1% in and 8-25% in decompensated patients. To determine the prevalence and characteristics of PV recanalization in cirrhotic patients with PVT. Descriptive, cross-sectional/prevalence. We reviewed medical records of all cirrhotic patients admitted with PVT diagnosis from January 2019 to April 2021. We included patients with a diagnosis of PVT. Qualitative variables were expressed as frequencies and percentages. The numerical variables were expressed as means and standard deviations. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of 553 cirrhotic patients admitted from January 2019 to April 2021, 48(8.67%) patients with PVT diagnoses were included. Of these, 27(56.3%) were women, with a mean age of 59.37±12.67 years, 9(18%) with a diagnosis of cancer, of which 8(16.7%) were hepatocellular carcinoma, 2(33.3%) extended to the two arms, 6(12.5%) received treatment, 100% of the treatment was based on low molecular weight heparin. According to the degree of recanalization: 37(77.08%) recanalized, 27(56.3%) did so partially, of them, 24(88.9%) were spontaneous; 10(20.8%) recanalized utterly, of which 90% were without treatment, with no significant difference between recanalization to free progression vs. treatment ( p =0.179) and 11(22.9%) did not recanalize. Regarding the characteristics of the thrombosis by imaging studies, 26(54.2%) were chronic, 28(58%) partial, only 9(18.8%) with cavernomatous transformation, 30(62.5%) were located in the main trunk, 6(12.5%) extended to the SLM and 11(22.9%) presented flow <15cm/s. In cirrhotics with recent or partial occlusion (> 50% of the lumen) or thrombosis of the main PV or SMV, therapy should be considered. Anticoagulant or interventional therapy has no benefit complete chronic occlusion of the main PV or cavernomatous transformation. Spontaneous recanalization occurs in 40% in 3 months, and with therapy, it is 80%. Several cohort studies reported that near 50% recanalize partially or totally in the next three months, and up to 80% recanalize at 12 months. Clinical trial data are weak regarding the indications for treatment for PVT without ischemic symptoms. Our study showed that 77.08% of cirrhotic patients with PVT recanalized, most partially during follow-up and more than 80% spontaneously, and only a low percentage presented with cavernomatous transformation. In addition, more than 70% of the patients who recanalized have a low risk of re-thrombosis related to flow. The prevalence of PVT in cirrhotic patients was relatively low (10%), complete or partial recanalization was very high, even spontaneously, there was no difference in the degree of recanalization with or without anticoagulation. The authors declares that there is no conflict of interest

S1169 Efficacy and Safety of Direct Oral Anticoagulants for the Treatment of Portal Vein Thrombosis in Patients With Liver Cirrhosis

Introduction: Studies have reported direct oral anticoagulants (DOACs) to be as effective and safe as traditional anticoagulants (TACs) for portal vein thrombosis (PVT) treatment in cirrhotic patients. However, ideal management remains ambiguous with limited data. Our study was to compare efficacy and safety of DOACs to TACs in cirrhotic patients with PVT. Methods: This is an institutional review board approved, retrospective chart review of four teaching hospitals from January 1st, 2015 to March 31st, 2021. Treatment response and safety were compared in cirrhotic patients on DOACs versus TACs, such as warfarin or low-molecular weight heparin, for PVT. Patients were excluded if they had received anticoagulation for conditions other than PVT, aged < 18, or were pregnant or breastfeeding. Data collected included anticoagulation agent, therapy duration, Child-Turcotte-Pugh class (CTP), radiographic imaging, and adverse medication reactions. We evaluated (1) the rate of progression, non-progression or recanalization of PVT and (2) rate of major bleeding, defined by a hemoglobin drop of ≥ 2, transfusion requirement, or need for reversal antidote. All other events were classified as minor bleeding. Results: A total of 527 patients had PVT and cirrhosis. Ninety-seven patients were initiated on anticoagulation, 53 met study inclusion criteria, and 27 had completed follow-up imaging. Of these 27 patients, 7 were CTP class A, 16 were B, 1 was C, and 3 were unknown at treatment initiation. Ten were on TACs and the remaining 17 were on DOACs. Seven patients (70%) on TACs vs. 14 (82.4%) on DOACs had resolution of PVT, 3 patients (30%) on TACs vs. 1 (5.9%) on DOACs had non-progression of PVT, and 2 (11.8%) on DOACs progressed without recanalization. Six patients (60%) on TACs vs. 14 (82.4%) on DOACs had resolution of PVT within 9 months of anticoagulation initiation. Three out of 10 patients (30%) on TACs and 3 out of 17 patients (17.6%) on DOACs had major bleed. No patients had minor bleed. There was no difference between treatment groups with respect to time of major bleed occurrence. Conclusion: Our study showed that DOACs were effective and safe for the treatment of PVT in patients with cirrhosis. Resolution of PVT in cirrhotic patients appeared to be slightly higher, and bleeding events lower, in those on DOACs compared to those on TACs. Large, prospective studies are warranted to elucidate the optimal use of DOACs in patients with cirrhosis, particularly in CTP class C.

Portal Vein Thrombosis is a Potential Complication of Coronavirus Disease 2019 in Cirrhotic Patients

Background. According to multiple reports, the incidence of thromboembolic complications has increased in patients infected with coronavirus disease 2019 (COVID-19), particularly in the elderly patients with severe illness and comorbid diseases such as diabetes and hypertension. Portal vein thrombosis (PVT) is a silent and rare venous thromboembolic disease occurring typically in patients with an underlying chronic liver disease, such as decompensated cirrhosis with or without hepatocellular carcinoma (HCC). This study aims to evaluate the incidence of occurrence of acute PVT in cirrhotic patients infected with COVID-19. Methods. This observational study involved 70 cirrhotic patients who were classified into Group A comprising 28 cirrhotic patients infected with COVID19, and Group B comprising 42 age- and sex-matched patients with liver cirrhosis as controls. All patients underwent a thorough medical history and examination. Routine investigations included complete blood count, liver, and renal function tests. Furthermore, imaging techniques such as abdominal and Doppler ultrasonography were used to determine the presence of acute PVT. Levels of serum ferritin, D-dimer, and C-reactive protein were determined, and COVID-19 RT-PCR was conducted for patients of Group A only. Results. Doppler ultrasound examination revealed a significant difference in the number of patients affected by PVT between the two groups. Three patients of Group A (10.7 %) and only one patient of Group B (2.3%) had PVT (P &lt; 0.05).Conclusion. Even in the absence of HCC, PVT could be a potential complication of COVID-19 in cirrhotic patients. Further prospective studies with longer follow-up may be needed for confirmation.

Study the relation of protein S and portal vein thrombosis in patients with liver cirrhosis

Objective The aim was to investigate serum protein S (PS) levels in cirrhotic patients with portal vein thrombosis (PVT). Background PS is an important guardian in controlling thrombin generation and fibrinolysis, although the contribution of these properties to the anticoagulant functions of PS is still unclear. Patients and methods The present study was conducted on 90 subjects who were classified as follows: 36 cirrhotic patients without PVT, 34 cirrhotic patients with PVT, and 20 healthy persons as a control. The study was conducted in the period between December 2010 and March 2012. Complete blood picture, liver function tests, and renal function test were done. PS was measured by enzyme-linked immunosorbent assay. Abdominal ultrasonography was done to confirm diagnosis of liver cirrhosis (LC) by giving idea about liver echogenicity, irregularity of liver outline, liver size, presence of liver nodules, and also portal vein diameter and presence of PVT. Results The mean PS level in the LC group was significantly lower than the mean level in the control group (P1 = 0.0123) and the mean PS level in LC with PVT group was highly significant lower than the control group (P2 Conclusion PS concentration is a potential biochemical marker in the diagnostic strategy of PVT in patients with cirrhosis. PS less than 3.15 is highly indicative of PVT in cirrhotic patients with high sensitivity but low specificity.

COVID-19 in Cirrhotic Patients; Is Portal Vein Thrombosis a Potential Complication?

Several studies showed that thromboembolic events increased in patients with corona virus infection, usually occurring in the elderly patients with severe illness, associated with comorbid diseases such as diabetes and hypertension. Portal vein thrombosis (PVT) is a rare venous thromboembolic disease occurring typically in patients with an underlying disease such as decompensated cirrhosis with or without hepatocellular carcinoma (HCC).Aim: evaluate incidence of occurrence of acute PVT in cirrhotic patients infected with corona virus disease (COVID19). Methods: This cross sectional, observational control study involved 70 patients of liver cirrhosis: group A (28 patients with liver cirrhosis infected with COVID19), in addition to 42 patients with liver cirrhosis as controls matched for age and sex (group B). All patients were subjected to thorough medical history, routine investigations (complete blood count, liver and renal function tests), imaging (abdominal and Doppler ultrasonography to assess the presence of acute PVT), Serum ferritin, D dimer, C- reactive protein, and PCR of COVID19 for group A only. Results: There was significant difference between the two groups regard Doppler ultrasound finding as 3 of the patients of group A had PVT (10.7%), and one patient only had PVT (2.3%) in group B (p Funding Statement: No Financial supportDeclaration of Interests: All authors declare no Conflict of interestEthics Approval Statement: Local Ethics Committee for human subject research reviewed and approved the study protocol and consent forms, all procedures performed in the study were in accordance with the ethical standards of the national research committee.

Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis

Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dysfunction have emerged as key factors in the pathogenesis of PVT. The contribution of PVT to hepatic decompensation and mortality in cirrhosis is debatable; however, the presence of an advanced PVT increases operative complexity and decreases survival after transplantation. The therapeutic decision for PVT is often determined by the duration and extent of thrombosis, the presence of symptoms, and liver transplant eligibility. Evidence from several cohorts has demonstrated that anticoagulation treatment with vitamin K antagonist or low molecular weight heparin can achieve recanalization of the portal vein, which is associated with a reduction in portal hypertension-related events and improved survival in cirrhotic patients with PVT. Consequently, interest in direct oral anticoagulants for PVT is increasing, but clinical data in cirrhosis are limited. Although the most feared consequence of anticoagulation is bleeding, most studies indicate that anticoagulation therapy for PVT in cirrhosis appears relatively safe. Interestingly, the data showed that transjugular intrahepatic portosystemic shunt represents an effective adjunctive therapy for PVT in cirrhotic patients with symptomatic portal hypertension if anticoagulation is ineffective. Insufficient evidence regarding the optimal timing, modality, and duration of therapy makes nontumoral PVT a challenging consequence of cirrhosis. In this review, we summarize the current literature and provide a potential algorithm for the management of PVT in patients with cirrhosis.

Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients With or Without Portal Venous Thrombosis.

To evaluate variations in coagulation, fibrinolysis and endothelial marker expression in cirrhotic patients and to explore their clinical value and predictive performance in cirrhotic patients with or without portal vein thrombosis (PVT), we performed a case-control study with 175 cirrhotic patients and 50 healthy individuals. 99 patients had PVT and another 76 patients did not. All participants were evaluated for plasma levels of conventional hemostatic markers. Thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (t-PAIC), von Willebrand factor antigen (vWF: Ag) and coagulation factor Ⅷ (FⅧ: c) were also assessed and the ratio of TAT/t-PAIC was calculated. We analyzed differences in these biomarkers among the three groups and constructed receiver operating characteristic (ROC) curves. Patients with PVT exhibited significantly higher TAT and TAT/t-PAIC than cirrhotic patients without PVT (both P < 0.001). Areas under the curve (AUC) of ROC analyses for TAT and TAT/t-PAIC were 0.68 and 0.66, the cut-off levels were 1.55 ng/ml and 0.46, with sensitivities and specificities of 78.79% and 51.32% regarding TAT, 39.8% and 90.79% regarding TAT/t-PAIC. Levels of FⅧ: c and vWF: Ag in patients with PVT were significantly lower than those without PVT (p = 0.026 and p = 0.027, respectively). The AUCROC, cut-off level, sensitivity and specificity of FⅧ: c were 0.64, 111.1%, 66.67% and 60%, respectively. For vWF: Ag they were 0.61, 429%, 89.66% and 38.71%, respectively. Cirrhotic patients have disorders of coagulation, fibrinolysis and the endothelial system. TAT, TAT/t-PAIC, FⅧ: c and vWF: Ag can be used as potential biomarkers for predicting PVT in cirrhotic patients.

Visceral fat is associated with cirrhotic portal vein thrombosis

ABSTRACTBackground: Central obesity, due to the accumulation of visceral fat(VF), is one of the main risk factors for venous thrombosis. The aim of this study was to determine if VF may be a risk factor for development of portal vein thrombosis(PVT) in cirrhotic patients.Methods: A total of 214 cirrhotic patients at the outpatient clinic were consecutively included, undergoing an anthropometric evaluation, blood tests and bioimpedance.Results: Median MELDscore was10. Prior liver decompensation occurred in 44.9% of patients and 35.6% of patients had large esophageal varices. Mean body mass index was 28.7 Kg/m2 (39.3%were obese) and mean waist circumference(WC) was 103.8 cm. A 7.5% of patients had PVT at the time of inclusion. PVT was more frequent in males(93.8 vs. 68.2%, p = 0.03). Patients with PVT had a higher WC(111.9 vs. 103.2 cm, p = 0.02) and VF (17.1 vs. 14.5, p = 0.04). PVT was also more frequent in patients with prior decompensation (81.3 vs. 41.9%, p < 0.01) and with large esophageal varices(62.5 vs. 33.3%, p = 0.02). In the simplified multivariate analysis, PVT was independently associated with the presence of portal hypertension(OR 13, 95%CI 1.6–108.3, p = 0.02) and VF(OR 1.2, 95%CI 1.03–1.3, p = 0.01).Conclusion: VF was independently associated with PVT in cirrhotic patients. VF may be more reliable than conventional anthropometric measurements for cirrhotic patients.

Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis.

Portal vein thrombosis (PVT), which is associated with reduced portalvein velocity, is considered to be an indicator for worse outcomes in liver cirrhosis. Nonselective beta-blockers (NSBBs), which are widely used for primary and secondary prophylaxis of esophageal variceal bleeding in liver cirrhosis, can significantly decrease the portal vein velocity. We proposed a hypothesis that the use of NSBBs might facilitate the development of PVT in cirrhotic patients. The PubMed, EMBASE, and Cochrane Library databases were searched. Major meeting abstracts and randomized-controlled trials regardingthe use of NSBBs in liver cirrhosis were also hand-searched. The number of patients who developed PVT in groups treated with or without NSBBs was pooled. Odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Subgroup meta-analyses were performed according to the type of studies,region, and study quality. Meta-regression and sensitivity analyses were performed to explore the source of heterogeneity. Nine of the 6416 retrieved papers were finally included. Overall, meta-analysis demonstrated that NSBBs were significantly associated with the development of PVT (OR 4.62, 95% CI 2.50-8.53; p < 0.00001). The heterogeneity was statistically significant (I2 = 80%; p < 0.00001). Subgroup meta-analyses still demonstrated a significantly positive association of NSBBs with the development of PVT in cohort studies (RR 2.57, 95% CI 1.46-4.51; p = 0.001) and case-control studies (OR 8.17, 95% CI 2.46-27.06; p = 0.0006). Sensitivity analyses based on subgroups find the source of heterogeneity. Based on the systematic review and meta-analysis, we found that the use of NSBBs increased a 4.62-fold risk of PVT in cirrhotic patients.

Risk factors associated with portal vein thrombosis in liver cirrhosis: A case-control study.

To build a predictive model for PVT in cirrhotic patients. A single centre case-control study was carried out. From the database of 1512 cirrhotic patients 94 with newly diagnosed PVT based on contrast-enhanced computed tomography were referred to the Case group. Malignant PVT was an exclusion criterion. Patients without PVT were stratified and matched according to sex, age and etiology of cirrhosis; case-control ratio was 1 : 3-4. The prevalence of PVT in the database, clinical, laboratory, instrumental parameters of the groups were evaluated. Logistic regression model was used to estimate association between variables and PVT. The overall prevalence of PVT was 6.2% with the highest rates among the patients with HBV infection - 16.7%, nonalcoholic steatohepatitis - 15.6%, alcohol abuse in combination with HCV infection - 11.7%. The best predictive model included variables: Child-Pugh classes B-C (coefficient of regression β=1.853, р=0.001), ascites (β=0.460, р=0.003), hepatocellular carcinoma without vascular invasion (β=2.126, р=0.0001), endoscopic band ligation (β=0.774, р=0.003), azygoportal disconnection (β=2.734, р=0.001), portal hypertensive gastropathy (β=0.793, р=0.017), portal vein diameter (β=0.203, р=0.004), and local factors - ulcerative colitis flare, Clostridium difficile enterocolitis, spontaneous bacterial peritonitis, colorectal cancer, splenectomy, cholecystectomy (β=2.075, р=0.017). The model had accuracy 85.8% (95% CI 81.7-89.4%), sensitivity - 55.1% (95% CI 43.4-66.4%), specificity - 95% (95% CI 91.6-97.3%), and AUC - 0.871 (95% CI 0.826-0.916). Child-Pugh classes B-C, severe portal hypertension, hepatocellular carcinoma without vascular invasion, and local factors were estimated as risk factors of PVT in cirrhotic patients.

Fondaparinux vs low molecular weight heparin in the treatment of non malignant portal vein thrombosis in patients cirrhosis

Nonmalignant portal vein thrombosis (PVT) is a common complication of cirrhosis. Anticoagulation is the first line option, but optimal regimen and dose are still to be determined. Despite many therapeutic options, there are no data regarding the use of fondaparinux (FPX) in the treatment of PVT in cirrhotic patients. The aim of our study was to compare safety and efficacy of FPX and LMWH in the treatment of PVT.

Risk factors of malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma

Introduction Hepatocellular carcinoma (HCC) is the sixth most commonly occurring cancer in the world and the second largest contributor to cancer mortality. In Egypt, liver cancer forms 11.75% of the malignancies of all digestive organs and 1.68% of the total malignancies. HCC constitutes 70.48% of all liver tumors among Egyptians. Malignant portal vein thrombosis (PVT) is a common phenomenon and is associated with poor prognosis. Knowing the risk factors of malignant PVT in HCC helps us in the management of the disease. Objective The objective of this study was to evaluate the risk factors of malignant PVT in cirrhotic patients with HCC. Patients and methods This was a case–control study that included 100 patients of HCC on top of liver cirrhosis. A total of 50 patients had HCC with malignant PVT, and the other 50 patients had HCC without malignant PVT, in the Internal Medicine department and Al-Raghy Liver Hospital between May 2016 and May 2017. Results This study showed that raised Model For End-stage Liver Disease score [odds ratio (OR)=1.34, 95% confidence interval (CI)=1.32–3.76; P = 0.02], low serum albumin (OR = 3.21, 95% CI = 2.11–3.21; P = 0.00) and raised α-fetoprotein (OR = 2.11, 95% CI = 1.09–4.11; P = 0.01) were independent predictors for malignant PVT in patients with HCC on top of liver cirrhosis. Conclusion High Model For End-stage Liver Disease score, low serum albumin and raised α-fetoprotein are major risk factors for malignant PVT in cirrhotic patients with HCC, and HCC with malignant PVT is associated with other comorbidities, high rates of hospital admission, larger tumor size and more recurrent tumors.