Resolution Of Portal Vein Thrombosis Research Articles

P239 Characteristics and outcomes of portal vein thrombosis in patients with Inflammatory Bowel Disease in Korea

Abstract Background Portal vein thrombosis (PVT) is known to occur frequently in patients with inflammatory bowel disease (IBD), particularly when compounded by factors such as abdominal infection, IBD flares, or intra-abdominal surgery. However, PVT can lead to diverse complications, causing acute issues like intestinal ischemia or necrosis and long-term problems such as portal hypertension, varices, and ascites. Nevertheless, there is a significant shortage of research regarding the characteristics and prognosis of PVT in the context of IBD. Particularly, with the rising prevalence of IBD patients in Asia, the authors conducted an evaluation of clinical presentation and prognosis of PVT in IBD patients at a large tertiary hospital in South Korea. Methods This study is a retrospective study conducted at a single tertiary center in South Korea. It examined patients aged 18 and above diagnosed with inflammatory bowel disease (IBD) who had confirmed portal vein thrombosis (PVT) between June 1, 1989, and December 15, 2021. The study focused on investigating patient characteristics, PVT characteristics, treatment methods, and outcomes. The diagnosis and resolution of PVT were confirmed using enhanced CT imaging. Results A total of 78 patients met the inclusion criteria for this study. Only 21% (16/78) received oral anticoagulants, yet nearly all patients (96%; 75/78) achieved Complete Radiologic Resolution (CRR). When comparing baseline characteristics between the anticoagulation use group and the non-use group, a trend was observed with a higher utilization of anticoagulants in cases where the main portal vein was involved rather than only the left or right portal vein (p-value 0.006). However, when conducting multivariable analysis, no factors significantly influenced CRR, especially anticoagulant use and surgery status. Conclusion PVT concomitant with IBD demonstrated favorable outcomes regardless of anticoagulation use.

Development and external validation of prognostic scoring models for portal vein thrombosis: a multicenter retrospective study

BackgroundPortal vein thrombosis is a common complication of liver cirrhosis and hepatocellular carcinoma; however, few studies have reported its long-term clinical prognosis. This study aimed to establish and validate easy-to-use nomograms for predicting gastrointestinal bleeding, portal vein thrombosis resolution, and mortality of patients with portal vein thrombosis.MethodsThis multicenter retrospective cohort study included 425 patients with portal vein thrombosis who were divided into training (n = 334) and validation (n = 91) sets. Prediction models were developed using multivariate Cox regression analysis and evaluated using the consistency index and calibration plots.ResultsPredictors of gastrointestinal bleeding included a history of gastrointestinal bleeding, superior mesenteric vein thrombosis, red color sign observed during endoscopy, and hepatic encephalopathy. Meanwhile, predictors of resolution of portal vein thrombosis included a history of abdominal infection, C-reactive protein and hemoglobin levels, and intake of thrombolytics. Predictors of death included abdominal infection, abdominal surgery, aspartate aminotransferase level, hepatic encephalopathy, and ascites. All models had good discriminatory power and consistency. Anticoagulation therapy significantly increased the probability of thrombotic resolution without increasing the risk of bleeding or death.ConclusionsWe successfully developed and validated three prediction models that can aid in the early evaluation and treatment of portal vein thrombosis.

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.

Characteristics, anticoagulation, and outcomes of portal vein thrombosis after intra-abdominal surgery

BackgroundIntra-abdominal surgery is a cause of portal vein thrombosis; however, postsurgical portal vein thrombosis has not been extensively described. MethodsThis is a retrospective study of 107 patients with postsurgical portal vein thrombosis followed for a median 25 months (interquartile range 11–51). Outcomes were complete radiographic resolution of portal vein thrombosis and development of clinical portal hypertension. ResultsSurgeries associated with portal vein thrombosis included colectomy (n = 42), bariatric surgery (n = 25), and splenectomy (n = 11). Presentations were nonspecific, typically characterized by abdominal pain. Sixty-three patients (59%) achieved complete radiographic resolution. On univariable analysis, provoking surgery, occlusivity of portal vein thrombosis, and anticoagulant used were associated with complete radiographic resolution. Colectomy was associated with a complete radiographic resolution rate of 30/42 (71%), bariatric 10/25 (40%), splenectomy 2/11 (18%), and other 21/29 (72%), (log rank P = .0033). Nonocclusive thrombus was associated with a complete radiographic resolution rate of 44/62 (71%), occlusive thrombus 19/45 (42%), (log rank P = .0101). Direct oral anticoagulants were associated with a complete radiographic resolution rate of 27/35 (77%), enoxaparin 20/29 (69%), warfarin 14/31 (45%), and no anticoagulant 2/12 (17%), (log rank P = .0002). On multivariable analysis, only anticoagulant choice was significantly associated with complete radiographic resolution. Using direct oral anticoagulants as reference, no anticoagulant yielded an adjusted hazard ratio of 0.10 for complete radiographic resolution (95% confidence interval 0.023–0.44), warfarin 0.40 (95% confidence interval 0.20–0.78), and enoxaparin 0.64 (95% confidence interval 0.49–1.60). Failure to achieve complete radiographic resolution was associated with greater risk of future clinical portal hypertension. Twenty-three patients (21%) went on to develop clinical portal hypertension; 20 who failed to achieve complete radiographic resolution (45%), and only 3 who achieved complete radiographic resolution (5%), (log rank P < .0001). ConclusionThe natural history of postsurgical portal vein thrombosis is variable and influenced by type of surgery, degree of occlusion, and, most notably, type of anticoagulant used. Failure to recanalize the portal vein carries considerable risk of future clinical portal hypertension.

Up to 50% of portal vein thrombosis remains undiagnosed until liver transplantation.

Impact of portal vein thrombosis (PVT) on the clinical course in liver transplant candidates remains unclear. This study aims to identify prevalence and risk factors for PVT, assess outcome after liver transplantation (LT) in patients with PVT and study the effect of anticoagulation. This single-center retrospective cohort study was performed from January 2006 until June 2016. Patients were stratified according to presence of PVT. Risk factors and outcome were assessed using logistic regression and survival analysis. Among 390 adults who underwent orthotopic LT, PVT occurred in 40 (10.3%). In, respectively, 10 (25%), 7 (17.5%), and 23 (57.5%) patients, PVT was identified at time of evaluation for transplantation, on the waiting list and during transplantation. A beneficial trend was present favoring the use of anticoagulation for PVT resolution (n=3/7 vs 0/9; p=.062). Patient and graft survival were similar between the groups after a median follow-up of 5years. However, 1-year patient survival was significantly lower (p=.031) in patients with PVT. Portal vein thrombosis occurred in 10% of patients awaiting LT was undiagnosed in 50% until moment of LT and had a deleterious effect on 1-year survival. Anticoagulation showed a beneficial trend on recanalization of PVT and survival rate.

S1085 Direct Oral Anticoagulants and Warfarin in Patients With Cirrhosis and Portal Vein Thrombosis: A Comparison of Outcomes

INTRODUCTION: Anticoagulation in cirrhotic patients with acute portal vein thrombosis (PVT) is poorly understood due to a paradoxical underlying prothrombotic statein the setting of elevated coagulation markers. Historically, treatment has included warfarin or low molecular weight heparin for at least 3-6 months. Direct oral anticoagulants (DOACs) may be an alternative but use in this population has been limited. This study evaluated the safety and efficacy of warfarin compared to DOAC therapy in cirrhotic patients with acute PVT requiring treatment. METHODS: This retrospective, observational, cohort study identified patients diagnosed with cirrhosis and acute PVT treated with either warfarin or DOAC therapy between January 2012 and July 2018 at a single US tertiary care academic medical center. Primary outcomes included rates of major bleeding on therapy and resolution of PVT with evidence of recanalization on imaging. Secondary outcomes were stroke, recurrent embolic events, all-cause mortality, and a composite endpoint of major adverse events at 1 year combining major bleeds, embolic events, and death. Chi-square tests were used for independent variables and student’s t tests were used to compare groups. RESULTS: 16 patients met inclusion/exclusion criteria (n = 11 on warfarin, n = 5 on DOACs). Groups showed no statistical difference in gender, age, race, BMI, or cirrhosis etiology, but the warfarin group had higher pre-treatment MELD scores (13.9 vs 9.0, P = 0.012). Resolution of PVT was higher in the warfarin group (54.5% vs 0%, P = 0.037). However, there were no statistical differences comparing warfarin to DOAC groups in major bleeding (18.2% vs 0%, P = 0.308), stroke (9.1% vs 0%, P = 0.486), recurrent embolic events (9.1% vs 0%, P = 0.486) or all-cause mortality (36.4% vs 40%, P = 0.889) at 1 year. The composite endpoint of major adverse events was also similar (36.4% vs 40%, P = 0.889). CONCLUSION: Providing adequate anticoagulation while balancing the risk for adverse bleeding events in patients with cirrhosis and concomitant PVT has not been well established. Our study is among the largest real-world comparisons of outcomes in this population. We demonstrated significantly improved rates of PVT resolution in patients treated with warfarin compared to DOACs with no significant differences in adverse outcomes. However, further research is needed to explore optimal anticoagulation regimens and monitor long-term outcomes for PVT in chronic liver disease.Table 1.: Baseline characteristicsTable 2.: Outcomes

The Use of Direct Oral Anticoagulants in Non-Cirrhotic Portal Vein Thrombosis

Introduction: Anticoagulation (AC) is the standard therapy for non-cirrhotic portal vein thrombosis (PVT). Professional society guidelines and expert opinions currently favor the use of vitamin K antagonists (VKAs) or low molecular weight heparins (LMWHs) for the treatment of PVT. Routine use of direct oral anticoagulants (DOACs) in PVT has often been met with concern due to a lack of data. We investigated the efficacy and safety of DOACs for the treatment of non-cirrhotic PVT, and compared them to standard therapies (VKAs and LMWHs). Methods: We conducted a retrospective review of patients treated at a tertiary care center. Patients were identified who had a documented PVT with or without concurrent thrombosis in additional splanchnic vessels, followed between 1/1/2000 and 2/1/2019. Patients were excluded if they had cirrhosis or tumor thrombus, received thrombectomy, lacked baseline imaging of PVT at diagnosis, or lacked subsequent follow-up imaging at least 3 months following diagnosis. The initial long-term AC used in each instance was recorded and formed the basis for comparison. In many cases intravenous heparin was used as initial short-term AC, and in these instances the first long-term AC transitioned to thereafter was regarded. The primary outcome was complete radiographic resolution of PVT (established on follow-up imaging). Secondary outcomes included recanalization (with or without complete resolution) of occlusive PVT, development of chronic portal hypertensive symptoms (cPHS, defined as new or worsening esophageal varices demonstrated on EGD, or new or worsening ascites requiring diuretic medications), and major (WHO grade 3 or 4) bleeding. Hazard ratios for each outcome were calculated via multivariable (MV) analysis. Results: A total of 330 patients were included. Their characteristics and treatments are described in Table 1. There were a variety of predisposing factors for PVT. Of note 27% (n=90) had no evident predisposing factor. A wide variety of ACs were used. Although the most commonly used ACs were the standard therapies warfarin (n=108) and enoxaparin (n=70), many patients received DOACs (n=93), most often rivaroxaban (n=65). Figure 1 shows the primary outcome of complete radiographic resolution (CR) stratified by AC. The CR rate was significantly higher among patients who received AC (49%) than those who did not (14%) (p &lt;.0001). Among anticoagulated patients, those who received DOACs had the highest rates of CR (dabigatran 6/8=75%, apixaban 13/20=65%, rivaroxaban 42/65=65%). Enoxaparin had a CR rate not significantly different from the DOACs (40/70=57%). Warfarin, with a CR rate of 31% (33/108), was the only AC inferior to others on MV analysis (HR for CR warfarin : rivaroxaban 0.36 (0.22 - 0.57, p&lt;.0001)). There were similar findings when comparing rates of recanalization of occlusive PVT (no AC 2/29= 7%, any AC 71/159=45%, dabigatran 4/5=80%, rivaroxaban 22/35=63%, apixaban 7/13 =54%, enoxaparin 16/36=44%, warfarin 21/68=31%). On MV analysis warfarin was inferior to each DOAC with respect to recanalization of occlusive PVT. Development of cPHS occurred in 30/57 (52%) of patients who received no AC compared with 52/273 (19%) of those who received AC (p=.0093). Although there was a trend toward less cPHS among those receiving rivaroxaban compared with warfarin (rivaroxaban 5/65=8%, enoxaparin 13/70=19%, warfarin 31/108=29%), this difference was not statistically significant on MV analysis. Major bleeding rates were not significantly different with or without AC, or among the various ACs. Among predisposing factors for PVT, patients harboring JAK2V617F had notably poor outcomes compared to those with other known predisposing factor (CR 8% vs 55% p=.0016; recanalization 16% vs 49% p=.0036; development of cPHS 49% vs 17% p=.5492). The 90 patients with no evident predisposing factor also demonstrated worse outcomes compared to those with evident non-JAK2 predisposing factors (CR 31% vs 55% p= .0152; recanalization 33% vs 49% p=.0896; development of cPHS 32% vs 17% p=.7406). Conclusions: DOACs are safe and effective for treatment of non-cirrhotic PVT. Use of warfarin is associated with inferior outcomes among non-cirrhotic PVT patients when compared with other forms of AC. Patients harboring JAK2V617, and to a lesser extent those without a clear predisposing factor for PVT, have inferior outcomes compared with other non-cirrhotic PVT patients. Disclosures Mascarenhas: Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding; Roche: Consultancy, Research Funding; Merck: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; CTI Biopharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Research Funding; Promedior: Research Funding; Merus: Research Funding; Pharmaessentia: Consultancy, Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: This abstract will discuss the use of direct oral anticoagulants including rivaroxaban, apixaban, and dabigatran, for anticoagulation of portal and other splanchnic vein thrombosis.

Utility of Transjugular Intrahepatic Portosystemic Shunt Placement for Maintaining Portal Vein Patency in Candidates on Wait Lists Who Develop Thrombus.

Although no longer a contraindication to liver transplant, portal vein thrombosis may lead to longer operative time and complexities in venous reconstruction. Strategies to maintain preoperative patency include systemic anticoagulation and/or transjugular intrahepatic portosystemic shunt placement. The former may not be ideal in cirrhotic patients prone to luminal gastrointestinal tract bleeding, and factors that predict improvements in portal vein thrombosis with the latter have not been well defined. Our goal was to evaluate the effectiveness of transjugular intrahepatic portosystemic shunt placement as monotherapy to improve and/or resolve portal vein thrombosis in otherwise eligible liver transplant candidates with partial or complete portal vein thrombosis and to identify factors predicting success. We identified 30 patients from 2010 to 2015 who had transjugular intrahepatic portosystemic shunt placementfor primary indication to maintain portal vein patency. The main portal vein was completely thrombosed in 5 of 30 (16.6%), nearly completely thrombosed in 9 of 30 (30%), and partially thrombosed in 16 patients (53.3%). Twenty-four patients (80%) had improvement and/or resolution of portal vein thrombosis after transjugular intrahepatic portosystemic shunt placement, with 18 of these (75%) having complete resolution. All 5 patients (20.8%) with complete thrombosis had improvement/resolution of portal vein thrombosis. Nine patients (30%) required hospitalization within 3 months for hepatic encephalopathy. There were 3 deaths (10%) not related to transjugular intrahepatic portosystemic shunt placement (10%). Nine patients underwent liver transplant after shunt placement (median 2.9 mo; range, 0.3-32 mo); all 9 received endto-end anastomosis without need for intraoperative thrombectomy. Transjugular intrahepatic portosystemic shunt placement may be effective as monotherapy for maintaining or restoring portal vein patency in selected livertransplant candidates, even in those with complete portal vein thrombosis. Further studies are needed to define potential responders to this approach.

The role of anticoagulation in pylephlebitis: a retrospective examination of characteristics and outcomes.

Pylephlebitis, or suppurative thrombophlebitis of the portal vein, typically occurs in the context of an intraabdominal infection or abdominal sepsis. Antibiotics are the mainstay of treatment. The role of anticoagulation in the management of pylephlebitis is controversial, and data regarding its impact on outcomes is limited. The records of 67 consecutive patients with pylephlebitis treated at our institution over a 19year period were retrospectively reviewed. Data was gathered regarding their baseline characteristics, presentations, management, and outcomes. Patients who did and did not receive anticoagulation were compared. Outcomes of interest included survival, portal vein thrombosis (PVT) resolution, development of chronic symptomatic portal hypertension, and major bleeding. Forty-seven patients received anticoagulation and 20 did not. The anticoagulated and non-anticoagulated groups did not differ significantly with respect to potential covariates or confounders. Anticoagulated patients had significantly higher rates of PVT resolution than non-anticoagulated patients (58% vs. 21%, p = 0.0201). This translated to lower rates of future chronic portal hypertensive symptoms among anticoagulated patients (11% vs. 47%, p = 0.0034). Anticoagulated patients had a trend toward improved survival however this improvement was not significant on multivariable analysis. There was no significant difference in rates of major bleeding between groups. Thrombophilia testing was common in this cohort however the occurrence of meaningful positive results was exceedingly low. Anticoagulation significantly improves the rate of PVT resolution, and significantly reduces the rate of chronic symptomatic portal hypertension, among patients with pylephlebitis. Treatment of pylephlebitis should incorporate the use of systemic anticoagulation whenever possible.

Abstract No. 585 The effects of transjugular intrahepatic portosystemic shunt procedures on resolution of portal vein thrombosis

Portal vein thrombosis (PVT) is commonly seen in patients with cirrhosis and can result in significant morbidity and mortality. The majority of these patients have contraindications to anticoagulation due to a high risk of bleeding and often undergo transjugular intrahepatic portosystemic shunt (TIPS) for treatment. The effect of TIPS on PVT in patients, who cannot undergo anticoagulation before or after TIPS, has not been well studied. This study investigates the connection between complete or partial recanalization of the portal vein after TIPS deployment. This study looked at patients with PVT who underwent TIPS procedures between 12/2016 and 09/2018. Patients who received any sort of lysis or anticoagulation therapies during TIPS were excluded. Preoperative PVT status was assessed via imaging and intraoperative venography. Post-TIPS PVT status was assessed via ultrasound or MRI between one month and 1 year after the procedure date. A binomial probability calculator was used to challenge the assumption that there is no relation between TIPS and portal vein recanalization. Preliminary data of 10 patients with PVT who underwent a primary TIPS placement without intraoperative thrombolysis and post op anticoagulation showed that 9 out of 10 had a significant reduction or total resolution of their pre-TIPS thrombus burden. The remaining one patient had no change in the extent of thrombosis. A binomial probability calculator showed the likelihood of at least 9 patients having an improvement in thrombus burden to be P < 0.001. Further results are pending and will include any patients with a mesenteric thrombus dating back to 2013. Preliminary findings are promising, demonstrating that 90% of patients had a decrease in thrombus burden with no patients that experienced worsening or progression of thrombosis. Findings would suggest that the TIPS procedure improves PVT. Continued review of patients treated between 2013 and 2016 is necessary before additional conclusions can be made.

Outcomes following neonatal portal vein thrombosis: A descriptive, single-center study and review of anticoagulant therapy.

Neonatal portal vein thrombosis (PVT) is uncommon with potentially serious complications that may manifest in infancy and childhood. The primary aim of our study was to describe the short-term and long-term outcomes of neonatal PVT. A retrospective chart review was conducted from 2008 to 2016 of neonates diagnosed with PVT. A systematic review was also performed from 2000 to 2018 to evaluate anticoagulant therapy (ACT) in neonatal PVT. Forty-four premature and 30 term infants (mean gestational age 30.7 vs 39.1weeks, respectively) had PVT. Sixty-eight involved the left portal vein, one involved only the main portal vein, and 5 involved ≥1 vein. PVT was catheter associated in 46 (62%); none of the 7 neonates tested had thrombophilia. Of 74 neonates, 19 (26%) received ACT and 55 (74%) were untreated. The mean follow-up duration was 16.6 months (SD=17.62; range, 0-89.6); 59.5% were followed for ≥6 months. On last ultrasound examination, thrombus resolution was documented in treated (ACT; n=19) and nontreated (n=55) neonates: 12 (63%) versus 32 (58%) with complete resolution, 1 (5%) versus 6 (11%) partial, 0 versus 1 (2%) extension, and 6 (32%) versus 16 (29%) had nonprogressive lesions, respectively. Seventy-one (96%) had no complications. Seventy-one articles met inclusion criteria for the systematic review and 19 were retained for analysis after assessment. PVT resolution rate was similar to previous reports. Although a low complication rate was detected, longer follow-up is necessary to determine the need for early treatment and the precise incidence of outcomes such as portal hypertension.

RETRACTED: Randomized controlled trial of rivaroxaban versus warfarin in the management of acute non-neoplastic portal vein thrombosis

Anticoagulation therapy is the main line of treatment for acute portal vein thrombosis (PVT) in the absence of cirrhosis. However, the use of this therapy in cirrhotic PVT is still with doubtful evidence. We aimed to evaluate the efficacy and safety of rivaroxaban compared to warfarin for the management of acute non-neoplastic PVT in Hepatitis C virus (HCV)-related compensated cirrhosis. Out of 578 patients with chronic HCV infection, 80 patients with acute PVT who had undergone splenectomy due to hypersplenism and 4 patients with acute PVT due to portal pyemia were selected. The patients were randomly assigned (1:1) to the study group (n = 40), in which the patients received rivaroxaban 10 mg/12 h, or the control group (n = 40), in which the patients received warfarin. In the rivaroxaban group, the resolution of PVT was achieved in 34 patients (85%) within 2.6 ± 0.4 months and delayed, partial recanalization after 6.7 ± 1.2 months (n = 6.15%). Complications such as major bleeding, abnormal liver functions, death, or recurrence did not occur during treatment, and patients in this group showed improved short-term survival rate (20.4 ± 2.2 months) compared to the survival rate in the control group (10.6 ± 1.8 months) in which warfarin achieved complete resolution in 45% of patients. Complications such as severe upper GI tract bleeding (43.3%), hepatic decompensation (22.5%), progression to mesenteric ischemia (12.5%), recurrence (10%), and death (20%) were observed in the control group. The duration until complete resolution of thrombus correlated with age, the extent of the thrombus, creatinine level, and MELD score. The recurrence after complete resolution of thrombus correlated with age, the extent of the thrombus, thrombogenic gene polymorphism, and the use of warfarin. Rivaroxaban was effective and safe in acute HCV-related non-neoplastic PVT with improved short-term survival rate; ClinicalTrials.gov Identifier: NCT03201367.

The Predictor Factors of Portal Vein Thrombosis in Pancreatitis Patients

Introduction: Portal vein thrombosis(PVT) is partial or complete occlusion of the portal vein. The most common causes of PVT are cancers, cirrhosis or/and severe inflammatory processes like pancreatitis. Our aim in this study is to determine the predicator factors that associated with the development of PVT in pancreatitis patients. Other objective of the study is to assess the recanalization rate after treating with the anticoagulation. Methods: A single center, retrospective chart review and analysis of patients with pancreatitis who had PVT between the age of 18 and 80 who were admitted to our institute between 2006 and January 2016. PVT diagnosis was confirmed by CT scans, MRI or ultrasound Doppler and been followed by images 3-6 months later to confirm the resolution or the extension of the thrombus. Results: Eighty patients with PVT-related pancreatitis were initially screened, 47 were excluded secondary to the presence of cirrhosis, cancers or lost in the follow up. A total of 33 patients, 24 acute and 9 chronic pancreatitis, were included in our cohort. The mean age of the cohort is 59 +/-16. Males represented 55% of the cohort and 45 % were females. Caucasian race represented 90% of the cohort. Seventeen patients (51%) had complications with the pancreatitis (fluid collections, pseudocyst or wall-off necrosis). Complete occlusion of the portal vein was found in 57.5% of the cohort while partial occlusion was found in 42.5%. Acute PVT was found in 89% of the cohort. Table 1 20(60%) patients received anticoagulation therapy, 5 patients had resolution of the PVT and 8 patients had an extension of the thrombus. 13(40%) patients did not receive treatment, 4 patients had resolution of the PVT and 5 had an extension of the thrombus. No deference was found between the group who treated with anticoagulation in terms PVT resolution or extension when compared to the non- treated group.Table 1Conclusion: Pancreatitis-related portal vein thrombosis is associated with acute and complicated forms of pancreatitis. Treatment with anticoagulation does not increase the chances of PVT resolution or prevention of the thrombus extension.Table 2

Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

ObjectiveLimited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered...

A Case of Steroid Resistant Minimal Change Disease Associated with Portal Vein Thrombosis Treated by Combined Immunosuppressive Agents

Minimal change disease (MCD) is a common cause of nephrotic syndrome and relatively well responds with steroid treatment. However, nearly half of patients with MCD experience recurrence of nephrotic syndrome. Thromboembolic events including renal vein thrombosis may occur in patients with MCD, but portal vein thrombosis rarely occurs. We experienced a case of frequent relapse/steroid dependent MCD with nephrotic syndrome progressed to steroid resistance associated with portal vein thrombosis. This patient showed complete remission of MCD and resolution of portal vein thrombosis after treatment with corticosteroid, cyclosporine, mycophenolate mofetil, and anticoagulant.

Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis.

Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis. The effects of anticoagulation on these patients were still unclear, especially for more advanced PVT. The aim of this study was to retrospectively assess the resolution of PVT and liver disease progression in a large cohort of cirrhotic patients with PVT with or without anticoagulation therapy. We analyzed data from 66 cirrhotic patients with PVT from January 2002 to June 2014. Thirty patients were anticoagulated with warfarin and 36 patients were untreated. PVT and hepatic decompensation were evaluated. For anticoagulated patients, the thrombosis had improved in 15 (68.2%) patients, was stable in four patients (18.2%), and progressed in three patients (13.6%). For untreated patients, the thrombosis had improved in four patients (25%), was stable in six patients (37.5%), and progressed in six patients (37.5%). The anticoagulation group had significantly better recanalization rates than the untreated group (P=0.011). Degree of superior mesenteric vein (P=0.032, hazard ratio: 15.4; 95% confidence interval: 1.3-200) was a significant predictor. In addition, anticoagulation can effectively improve PVT with a degree less than 75% in the main portal vein compared with untreated patients (6/6 vs. 2/6, P=0.030). The probability of hepatic decompensation at 1 year was 15.6 and 17.9% between the anticoagulation and the untreated groups (P=0.847). Albumin (P=0.06, hazard ratio: 0.860; 95% confidence interval: 0.772-0.959) was a significant predictor. Anticoagulation with warfarin might result in the resolution of more advanced PVT effectively and safely in patients with liver cirrhosis. In addition, we did not demonstrate the benefit of anticoagulation for the decompensation or death.

Su1018 The Role of Anticoagulation for Portal Vein Thrombosis Prior to Orthotopic Liver Transplantation

Portal vein thrombosis (PVT) is common complication in the setting of end stage liver disease. The presence of PVT in the setting of orthotopic liver transplantation (OLT) can be associated with the need for additional anastomoses and potentially reduced survival. The goal of anticoagulation is to achieve partial recanalization to allow end-to-end portal vein anastomosis. Our AIM was to determine the impact of anticoagulation for PVT when indicated on recanalization of the portal vein at the time of OLT and on post OLT outcomes. Methods : This is a single center retrospective study of all patients who underwent OLT who were previously diagnosed with PVT between March 2011 and July 2014. The study included all patients over age 18 with PVT diagnosed by CT or MRI and who subsequently underwent OLT. Data abstracted included demographic data, anatomic extent of PVT, presence/type of anticoagulation, effect on PVT, complications of anticoagulation, and outcomes after transplant including use of jump graft and survival. PVT was classified as occlusive or non-occlusive involving portal vein with or without extension. The decision to anticoagulate was made by a multidisciplinary team at selection conference. Results: 43/333 (13%) patients were diagnosed with PVT before OLT by axial imaging. Median age was 59 years (IQR= 52-63), 27/43 male, median BMI 28 (IQR= 25.7-33), median MELD score 20 (IQR= 17-25). PVT was diagnosed at median of 338 days prior to OLT. In 30/43 patients anticoagulation was initiated (27 warfarin, 3 enoxaparin) prior to OLT for median duration of 9 months (IQR 5 17). The median time to demonstrated improvement or resolution of PVT was 5 months (IQR 37.2). 19/30(63%) of anticoagulated patients achieved partial to full PVT resolution at time of OLT compared to 8/14 patients (57%) in whom no anticoagulation was initiated. 3 patients with partial or full resolution of PVT had recurrent thrombosis post OLT. 3 patients required jump grafts due to thrombosis. In the entire PVT cohort, there were 5 deaths post OLT (2 no anticoagulation, 1 warfarin, 2 enoxaparin). 1 month survival (no anti-coagulation 86% ;warfarin 100%;enoxaparin 67%), 6 month survival (no anti-coagulation 86% ;warfarin 96%%;enoxaparin 33%)and 1 year survival (no anti-coagulation 85% ;warfarin 94%;enoxaparin 0%) were superior in the warfarin treated group compared to enoxaparin or no anticoagulation (p<0.05). Bleeding complications were rare with no difference noted between the anticoagulated and non-anticoagulated groups. Conclusion: Anticoagulation for PVT prior to OLT is safe, and lead to partial or complete resolution in 19/30 patients. Improved survival was noted in the PVT cohort who received anticoagulation with warfarin prior to OLT. Data collection is ongoing to better refine which PVT patients derive benefit with this strategy.

Portal Venous Thrombosis After Distal Pancreatectomy: Clinical Outcomes

AimOutcomes of patients developing portal vein (PV) thrombosis (PVT) after distal pancreatectomy (DP) are unknown. The goal of this study was to identify risk factors for PVT and describe the long-term outcomes in these patients. MethodsPatients undergoing DP without repair or reconstruction of the PV between 2001 and 2011 were included. Patients that showed evidence of PVT on pre-operative imaging were excluded from the study. Location and extent of thrombosis was determined by post-operative computed tomography or ultrasound imaging in all patients. Evidence of systemic thrombosis (if present) in addition to PVT was also documented. ResultsIn the study period, 991 patients underwent DP and 21 (2.1 %) patients were diagnosed with PVT. Pancreatic neoplasm was the most frequent indication for operation (n = 11). Thrombus occurred in the main PV in 15 and the right branch of the PV in 8 patients. Complete PV occlusion occurred in nine patients with a median time to diagnosis of 16 days (range 5–85 days). Seventeen patients were anticoagulated for a median duration of 6 months (range 3.3–36 months) after the diagnosis of PVT. Over a median follow-up of 22 months, resolution of PVT occurred in seven patients. Predictors of non-resolution of PVT included anesthesia time >180 min (p = 0.025), DM type II (p = 0.03), BMI >30 Kg/m2 (p = 0.03), occlusive PVT (p < 0.001), or thrombus in a sectoral branch (p = 0.02). Anticoagulation therapy did not influence the frequency of thrombus resolution and was complicated by gastrointestinal hemorrhage in four patients. There was no mortality as a direct result of PVT or anticoagulation. ConclusionPVT after distal pancreatectomy is a rare complication. Serious complications as a direct result of PVT in this setting are uncommon and are not dependent on thrombus resolution. Although anticoagulation does not appear to influence the rate of PVT resolution in this small retrospective series, we support the use of anticoagulation until larger, controlled studies define clear advantages or disadvantages.

PORTAL VEIN THROMBOSIS IN PATIENTS WITH LIVER CIRRHOSIS ;RISK FACTORS,CLINICAL PRESENTATION AND OUTCOME

Introduction: The liver has many haemostatic functions, including the synthesis of most coagulation factors and inhibitors as well as fibrinolytic factors . The balance between procoagulant and anticoagulant factors is essential to avoid excessive thrombin generation under physiological conditions. Therefore, advanced liver disease results in a complex pattern of defects in haemostatic functions in the form of reduced synthesis of coagulation factors, inhibitors, and abnormal clotting factors, abnormalities of fibrinolytic activity, disseminated intravascular coagulation and platelet function defects. Development of portal vein thrombosis (PVT) is asignificant milestone in the natural history of cirrhosis. It is associated with worsening liver function, ascites, and the occurrence of gastroesophageal variceal bleeding. It is clear that PVT increases morbidity and mortality associated with liver transplant and may even contraindicate it and. Thus, taken together, these data suggest that PVT is a major index of poor prognosis in patients with cirrhosis. Although spontaneous resolution of PVT has been reported in the literature specific therapeutic management is mandatory to resolve portal vein obstruction and avoid serious complications. The goal of treatment is similar correction of causal factors, prevention of thrombosis extension, and achievement of portal vein patency Objective: the aim of the work was to clarify the risk factors , clinical presentation and complications of portal vein thrombosis in patients with liver cirrhosis and to study the out come after short term follow up. Subject and methods :- A total number of 80 patients with cirrhosis were included and were classified into two main groups. Group I ( 50 ) cirrhotic patients with portal vein thrombosis. Group II ( 30 ) cirrhotic patients without portal vein thrombosis. Each group was divided in two sub groups A and B a ccording to prescence or absence of HCC respectively.The 2 groups were compared as regard risk factors and clinical presentation and out come. Result: PVT developed as result of combination of both local and systemic risk factors. HCC and abdominal infection specially spontaneous bacterial peritonitis and intervention to the portal system ,were the most important local risk factors . Protein C and S defficincy were amog systemic risk factors. Most of cases were asymptomatic and accidentally discovered , other patients presented with upper GIT bleeding or other complications of liver cell failure .Anticoagulant administration was associated with increased incidence of partial or complete recanalization without increased risk of bleeding. Conclusion and Recommendations:- Portal vein thrombosis occurs mostly in a cirrhotic patient with advanced liver disease. Patients with advanced liver cirrhosis and not so prolonged coagulation parameters might be at particular risk of developing PVT. So regular monitoring using Doppler-ultrasound should be carried out in these patients. Development of varices is a time dependent phenomenon, so it is advisable to screen all PVT patients endoscopically.Early administration of anticoagulation was associated with increased incidence of partial or complete recanalization. Keywords :Portal vein ,Thrombosis, risk factors, cirrhosis

Hydatid cyst of liver complicated with Budd-Chiari syndrome and portal vein thrombosis

Hydatid cyst of liver complicated with Budd-Chiari syndrome and portal vein thrombosis