Prevalence Of Portal Vein Thrombosis Research Articles

Portal Vein Thrombosis in COVID-19: An Underdiagnosed Disease?

Background: Multiple studies have linked COVID-19 to a higher incidence of thromboembolic disorders. However, the association of COVID-19 with other potentially life-threatening complications, such as splanchnic vein thrombosis, is less well understood. This study aims to assess the prevalence, patient characteristics, clinical presentation, and outcomes of patients with portal vein thrombosis (PVT) and COVID-19. Methods: This was a retrospective observational study. From all positive patients for a reverse-transcription polymerase chain reaction (RT-PCR) swab test from March 2020 to June 2020, we included those who were older than 18 years, had received abdominal contrast-enhanced computed tomography (CT) in the 6 months following the positive RT-PCR swab, and had no previously known splanchnic vein thrombosis. Results: A total of 60 patients with abdominal CT were selected from all those positive for SARS-CoV-2 (n = 2987). The prevalence of PVT was 3/60 (5%). The mean age was 66.1 ± 16.5 years and 51.7% were male. In two of the three patients, there was no underlying pathology as a risk factor for PVT and one of them presented cirrhosis. The number of days from the start of COVID-19 symptoms until the PVT diagnosis were 21, 12, and 10 days. Anticoagulation treatment achieved recanalization in 100% of cases. During a mean follow-up of 803 days, none of the patients experienced long-term complications. Conclusions: Portal vein thrombosis is uncommon, and its incidence may be higher in COVID-19 patients. A greater understanding of the features of this disease in the context of COVID-19 could aid towards its diagnosis and allow for early detection and management.

Effect of sarcopenia on liver cirrhosis with complicating oesophageal and gastric varices after endoscopic therapy

Several investigators have reported that sarcopenia is common in patients with liver cirrhosis. However, few studies have probed the association between sarcopenia and liver cirrhosis complicated with oesophageal and gastric variceal bleeding (LC-EGVB). We aimed to investigate the impact of sarcopenia on rebleeding after endoscopic therapy in patients with LC-EGVB. Computed tomography (CT) radiographs from the third lumbar vertebra were selected to analyse body composition, including skeletal muscle tissue, visceral and subcutaneous adipose tissue using SliceOmatic software. Sarcopenia was defined using validated cutoff values for patients with liver cirrhosis: 44.77 cm2/m2 for men and 32.50 cm2/m2 for women. A total of 187 patients with LC-EGVB and 309 controls were included in this study. The rate of sarcopenia in controls (17.4 %) was significantly lower than that in patients with LC-EGVB (41.2 %). Patients with LC-EGVB exhibiting sarcopenia showed a high prevalence of portal vein thrombosis and rebleeding rate at 1 year. The rate of sarcopenia in the rebleeding group was significantly higher than that in the non-rebleeding group. Univariate and multivariate analyses showed that sarcopenia was an independent risk factor for rebleeding within 1 year in patients with LC-EGVB. Patients with LC-EGVB displayed a high prevalence of sarcopenia. Sarcopenia was observed to be an independent risk factor for rebleeding within 1 year.

Portal vein thrombosis in gastrointestinal cancers: Insights into prevalence and prognosis—A nationwide inpatient analysis 2018-2020.

e16382 Background: The relation between cancer and thrombotic events has been well established over the past decade. Cancer is a prothrombotic state and thrombosis is the second most common cause of death in cancer. While portal vein thrombosis (PVT) has been extensively studied in individuals with Hepatocellular Carcinoma (HCC), its significance in other Gastrointestinal (GI) cancers is often overlooked. This study aims to investigate the prevalence and prognostic impact of PVT across various GI cancers. Methods: A retrospective analysis was performed on the National Inpatient Sample database (2018-2020) and the ICD-10 codes to identify the patients > 18 years old with primary diagnosis of GI cancers (pancreatic, HCC, gastric, small intestinal[SI], colorectal). Prevalence of PVT in individual GI cancers and effect of PVT on mortality, length of stay and Hospital cost utilization was studied. Multivariable regression analyses were performed adjusting for demographics, hospital-level characteristics, and relevant comorbidities. These included Age, Sex, Race, obesity, Smoking, Hypertension, Diabetes, CKD, liver disease, CHF, CAD, Hypothyroidism. Results: Our study analyzed data from 2,313,888 individuals with GI cancers, Including HCC, Gastric cancer, SI cancer, colorectal and pancreatic cancer, The incidence of PVT varied across cancer types, with 12.9% in pancreatic cancer, 0.74% in HCC, 0.99% in gastric cancer, 0.47% in colorectal cancer, and 3.6% in pancreatic cancer. Multivariate regression analysis, adjusting for confounders, revealed a significant association between PVT and increased mortality in various GI cancers. Specifically, the odds ratio (OR) for mortality in pancreatic cancer was 1.31 (p < 0.001), in HCC was 1.39 (p < 0.001), in gastric cancer was 1.88 (p < 0.001), and in colorectal cancer was 2.10 (p < 0.001). However, the incidence of mortality in SI cancer did not yield a significant result OR 1.42 [p- value 0.369] [Table 1]. Additionally, Our findings revealed an increase in length of stay and total healthcare resource utilization across all GI cancers for individuals with PVT compared to without PVT. Conclusions: There is a statistically significant effect of symptomatic and asymptomatic PVT on mortality in various other GI cancers in addition to HCC, which has been established and studied widely. Further prospective studies are needed to study the effect of diagnosing PVT earlier in the disease to predict mortality and other major complications in GI cancers.[Table: see text]

Systemic Thrombolysis of Acute Portal Venous System Thrombosis in Patients with Liver Cirrhosis: A Pilot Study

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.

Assessment of Portal Vein Thrombosis in Cirrhotic Liver Patients

Background: PVT has a number of frequent causes, including cirrhosis of the liver, abdominal inflammation, tumour invasion, and thrombophilic disorders. Aim: To find out how frequently liver cirrhosis patients get portal vein thrombosis. Study Design: Cross-sectional study, Department of Medicine, Liaquat University Hospital Hyderabad, Sindh, Pakistan's from 1st April 2021 to 30th September 2021.One hundred and twenty eight patients were enrolled. The demographic information like age, sex, and body mass index were noted. Hepatocellular carcinoma patients and history of thromboembolism propensity were excluded. Both male and female patients with hepatic cirrhosis and age ranged from 20 to 50 were included. The monitoring of portal vein thrombosis, Doppler ultrasonography was performed on all patients. Results: There were 40(34.4%) female patients and 84(65.6%) male patients with average age was 51.95 7.54 years and BMI was 31.87 2.64 kg/m2. Seventy nine patients (61.7%) had hepatitis C, 50 patients (39.3%) had hepatitis B, 66 patients (51.6%) had diabetes mellitus, 81 patients (63.3%) had hyperlipidaemia, and 69 patients (57.9%) had hypertension. The prevalence of portal vein thrombosis (PVT) was 81(63.3%), with 48(59.3%) of the cases involving men and 33 (40.7%) involving females. Of them, 25 patients (50%) had hepatitis B and 44 (55.7%) had hepatitis C. Conclusion: Patients with liver cirrhosis experienced portal vein thrombosis often, and hepatitis C patients made up the majority of those afflicted. Keywords: Thrombosis, Portal vein, Liver cirrhosis, thrombophilic disorders

Portal vein thrombosis in patients with liver cirrhosis

Background/Aim. Portal vein thrombosis (PVT) in patients with liver cirrhosis (LC) has a prevalence of 0.6- 26%. It is most commonly discovered incidentally as part of the evaluation of LC or in the context of acute decompensation of LC due to portal hypertension. The aim of the study was to determine the prevalence of PVT in patients with LC in relation to the severity of the disease and individual elements of portal hypertension. Methods. A total of 326 patients treated for LC decompensation were included in a retrospective study. Standard laboratory analyses, abdominal ultrasonography and/or computed tomography, and esophagogastroduodenoscopy were performed. Results. The diameter of the portal vein (PV) differed between patients without esophageal varices (12.2 mm) and those with large varices (13.6 mm), p = 0.026. PVT was identified in 6.1% of patients with LC. The patients were classified according to the Child-Pugh scoring system, which has the A, B, and C categories used to assess the severity of liver disease. PVT was present in 3.0% of patients in class C and 12.0% in class B, while none of the patients in class A had PVT (p = 0.005). PVT was present in 4.4% of patients with small varices and 16.7% with large varices (p < 0.001). There was no difference in the presence of PVT between the groups of patients with and without variceal bleeding nor between groups with different degrees of ascites. A fatal outcome occurred in 29.4% of patients, but there was no difference between patients with and without PVT. Conclusion. PVT is present in more advanced stages of LC and predominantly in patients with large esophageal varices. There was no higher prevalence of PVT observed with the occurrence of variceal bleeding or with the death outcome in patients with LC.

A nomogram model to predict the portal vein thrombosis risk after surgery in patients with pancreatic cancer.

Portal vein thrombosis (PVT) is a common postoperative complication in patients with pancreatic cancer (PC), significantly affecting their quality of life and long-term prognosis. Our aim is to establish a new nomogram to predict the risk of PVT after PC surgery. We collected data from 416 patients who underwent PC surgery at our hospital between January 2011 and June 2022. This includes 87 patients with PVT and 329 patients without PVT. The patients were randomly divided into a training group and a validation group at a ratio of 7:3. We constructed a nomogram model using the outcomes from both univariate and multivariate logistic regression analyses conducted on the training group. The nomogram's predictive capacity was assessed using calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). In the study, the prevalence of PVT was 20.9%. Age, albumin, vein reconstruction and preoperative D-dimer were independent related factors. The model achieved a C-index of 0.810 (95% confidence interval: 0.752-0.867), demonstrating excellent discrimination and calibration performance. The area under the ROC curve of the nomogram was 0.829 (95% CI: 0.750-0.909) in the validation group. DCA confirmed that the nomogram model was clinically useful when the incidence of PVT in patients was 5%-60%. We have established a high-performance nomogram for predicting the risk of PVT in patients undergoing PC surgery. This will assist clinical doctors in identifying individuals at high risk of PVT and taking appropriate preventive measures.

Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease: a meta-analysis of observational studies.

Portal vein thrombosis (PVT) is a common complication of cirrhosis as a result of portal hypertension and modification in the hemostatic balance. Accumulating evidence now suggests that patients with non-alcoholic fatty liver disease (NAFLD), especially those with advanced forms, have an increased risk of PVT. Hence, we performed a meta-analysis of observational studies to estimate the overall prevalence of PVT in patients with NAFLD and its advanced forms compared with patients with advanced liver diseases from other etiologies.We systematically searched PubMed, Scopus and Web of Science databases from the inception date to December 30th 2022, using predefined keywords, to identify observational studies. Meta-analysis was performed using random-effects modeling.We included five observational studies for a total of 225,571 patients. Of these, 26,840 (11.9%) patients had NAFLD, whereas the PVT prevalence was 8.5% (n = 2,280). When compared with patients with advanced liver diseases from other etiologies, patients with NAFLD and its advanced forms had a higher risk of prevalent PVT (OR 1.34, 100% CI 1.07-1.67 p < 0,01). The between-study heterogeneity was substantial (I2 = 88%).This meta-analysis suggests that compared with patients with advanced liver diseases from other etiologies, patient with NAFLD and its advanced forms had a higher risk of prevalent PVT. Further research is required to understand the complex link between NAFLD/NASH and PVT development.

Portal Vein Thrombosis in Patients With Cirrhosis of the Liver: Prevalence and Risk Factors.

Chronic liver disease very often culminates into cirrhosis and its associated complications. One of the serious complications is portal venous thrombosis, which can occur due to a variety of risk factors. One significant factor contributing to portal hypertension is portal vein thrombosis (PVT).In this study, we aimed to investigate the prevalence of PVT among patients with liver cirrhosis in a tertiary hospital and identify the factors associated with this complication. This was a cross-sectional observational study of 93 diagnosed liver cirrhosis patients treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in southern India between June 2020 and January 2021.A thorough evaluation of the clinical condition of the patients and associated comorbidities was done. The patients then underwent Doppler ultrasound/CECT/MRI to look for PVT and its extent. The collected data were analyzed using Statistical Product and Service Solutions (SPSS, version 24) (IBM SPSS Statistics for Windows, Armonk, NY). Comparison between two proportions was done using two two-tailed Z-test/Fisher's exact tests. Our study found a PVT prevalence of 17.2% in cirrhotic patients, with a higher prevalence of acute PVT than chronic PVT. Ascitic fluid infection, longer duration of cirrhosis, and increased cirrhosis severity were significantly associated with PVT development. We found no significant associations between PVT and gender, hypertension, smoking, diabetes, or the duration of alcohol intake. This study highlights the importance of early screening for PVT using Doppler USG in all patients diagnosed with cirrhosis. Additionally, anticoagulation therapy for acute PVT may be considered in patients without bleeding risks.

Allogeneic Vessels in Pancreaticoduodenectomy with Portal Vein Resection: Risk of Portal Vein Thrombosis and Prognosis

BackgroundAllogeneic vessels (AV) are commonly used in pancreaticoduodenectomy (PD) with portal vein resection (PVR), but the epidemiological characteristics of portal vein thrombosis (PVT) are still unclear. MethodsThe clinicopathological data of patients who underwent PD combined with PVR in our hospital from January 2011 to October 2022 were retrospectively collected. All patients underwent regular contrast-enhanced CT of the abdomen after surgery to identify PVT or recurrence and metastasis of the tumor. ResultsA total of 878 patients received PD, of which 213 patients who also underwent PVR were included in the study. Among them are 16 (7.5%) tangential/patch reconstructions, 51 (23.9%) end-to-end anastomosis, and 146 (68.5%) AV reconstructions. The cumulative incidence of PVT in 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after surgery was 0.9%, 7.3%, 7.3%, 15.9%, 23.4%, and 27.6%, respectively. The results of logistic regression analysis showed that diabetes, operation procedure, and AV reconstruction were independent risk factors for PVT (P < 0.05). In the Cox analysis, PVT was clearly correlated with tumor recurrence (P = 0.038, hazard ratio (HR) = 1.553) and overall survival (P = 0.044, HR = 1.592) of pancreatic cancer patients. ConclusionThe prevalence of PVT is high in PD with PVR, particularly in patients undergoing AV reconstructions. The occurrence of PVT has a clear correlation with the patient’s long-term prognosis.

THE SURGEON'S PERSPECTIVE ON PORTAL VEIN THROMBOSIS IN PATIENTS WITH LIVER CIRRHOSIS

The article discusses the key aspects of the etiology, diagnosis, and treatment of portal vein thrombosis in patients with liver cirrhosis. The prevalence of portal vein thrombosis in individuals with liver cirrhosis ranges from 0.6 % to 26 %, with a higher incidence observed in those with decompensated cirrhosis. Symptoms of portal vein thrombosis are often nonspecific. Approximately one-third of patients with this condition experience no symptoms, and the detection of a thrombus is usually an incidental finding during computed tomography or ultrasound examinations.&#x0D; Acute portal vein thrombosis is characterized by abdominal pain in the right upper quadrant, non-bloody diarrhea, or acute intestinal obstruction when there is symptomatic dilatation of the superior mesenteric vein. On the other hand, chronic portal vein thrombosis manifests through signs of portal hypertension, such as esophageal and gastric bleeding, deterioration of portal gastropathy, splenomegaly, pancytopenia, and significant ascites.&#x0D; The first-line treatment for portal vein thrombosis involves the use of direct and indirect anticoagulants. However, their administration necessitates careful consideration of the risk of intraluminal bleeding, the severity of cirrhosis, and the potential benefits of portal vein recanalization. Mechanical thrombectomy can serve as an alternative to long-term anticoagulant therapy for portal vein thrombosis. In cases of portal vein thrombosis in patients with cirrhosis, after mechanical thrombectomy and thrombolysis, the placement of transjugular intrahepatic portosystemic shunt (TIPS) is often performed.&#x0D; To conclude, portal vein thrombosis frequently occurs in patients with liver cirrhosis, and its appearance is challenging to predict due to its multifactorial nature. The preferred initial treatment for acute portal vein thrombosis, in the absence of intraluminal bleeding or intestinal ischemia, involves the use of direct and indirect anticoagulants. Minimally invasive surgical options, such as mechanical thrombectomy, chemical thrombolysis, and TIPS placement (with or without variceal embolization), are currently available. However, due to the heterogeneous nature of the existing data and the lack of randomized controlled trials, definitive recommendations regarding the optimal treatment strategy are not yet available.&#x0D; Keywords: cirrhosis, coagulopathy, portal hypertension, portal vein thrombosis, anticoagulants.

Association of nonalcoholic fatty liver disease with acute cholangitis: a nationwide propensity-matched analysis from the United States

Background Nonalcoholic fatty liver disease (NAFLD) has previously been linked to several disease states with an impact on patient outcomes. However, clinical evidence on the association between NAFLD and acute cholangitis (AC) remains scarce. We aimed to evaluate the potential association between NAFLD and AC. Methods We conducted a retrospective cohort study using the US National Inpatient Sample database from 2016 to 2019 to analyze primary AC hospitalizations with NAFLD compared to non-NAFLD in a 1:1 propensity-matched population. Results A total of 1550 AC patients with NAFLD were matched to 1550 AC patients without NAFLD. NAFLD had a higher association with AC when compared to patients without NAFLD, with an odds ratio of 2.33 (95% CI [1.81–3.0], P < 0.001). The length of stay was higher in NAFLD than in non-NAFLD (4 vs 3 days, P < 0.001). The median inpatient charges in NAFLD were also higher than in the non-NAFLD cohort ($36,182 vs $35,244, P < 0.001). Inpatient mortality was higher in NAFLD compared to non-NAFLD (1.6% vs 0%, P < 0.001). There was an increased prevalence of portal vein thrombosis (3.2% vs 0%), acute kidney injury (24.2% vs 17.7%), sepsis (3.2% vs 1.6%), mechanical ventilation (3.2% vs 0%), and percutaneous cholecystostomy tube insertion (3.2% vs 1.6%) in NAFLD compared to non-NAFLD (P < 0.05). NAFLD also had a higher association with acute cholecystitis, with an odds ratio of 3.70 (95% CI [3.19–4.29], P < 0.001). Conclusions This study showed an association between NALFD and AC, resulting in increased length of stay, hospital charges, and inpatient mortality. Underlying NAFLD also increases acute complications of AC.

Anomalies and malformations of visceral arteries in children with extrahepatic portal vein obstruction

Purpose. To study the incidence of anomalies and malformations of visceral arteries and evaluate their role in the treatment of extrahepatic portal vein obstruction (EHPVO) in childrenMaterial and Methods. The study included 155 previously not operated children with EHPVO. A retrospective analysis of the results of three-phase multislice computed tomography with angiography (MSCTA) of visceral vessels was performed. Frequency of visceral arteries anomalies of the abdominal aorta, aortomesenteric angle, the structure of the hepatic, splenic and superior mesenteric arteries (SMA) were assessed. The size of visceral arteries depending on the prevalence of portal vein thrombosis was also assessed.Results. According to analysis 35 (22.6%) children with EHPVO had abnormalities of visceral arteries. Of them, 14 (11.7%) patients presented with signs of aortomesenteric compression of the left renal vein (LRV). Coeliacomesenteric trunk was detected in 4 (2.5%) children. In one (0.64%) case there was sign of saccular splenic artery (SA) aneurysm. According to data, there was a significant correlation of the diameter of SA and SMA with the age of children (r = 0.58; p = 0.001). According to the study, diameter of arteria hepatica propria in children with portal vein thrombosis (PVT) with extension into superior mesenteric vein (SMV) was significantly lower than in PVT and its branches (2.48 ± 0.23 mm vs 3.15 ± 0.08 mm, p = 0.01). The diameter of SA in children with PVT extended into splenic vein was significantly smaller (4.26 ± 0.19 mm) in comparison to children with PVT and its branches (4.9 ± 0.12 mm, p = 0.01), and children with widespread thrombosis of portal vein system (5.45 ± 0.41 mm, p = 0.05).Conclusion. Multiple aberrations of the anatomical structures of visceral arteries make any hepatobiliary surgery challenging to surgeons. The study data suggest that MSCTA is an informative method for evaluation of associated anomalies of visceral arteries in children with EHPH.

Prevalence of Portal Vein Thrombosis in Budd-Chiari Syndrome Patients

Background and Aim: Thrombosis of the portal vein or obstruction of the hepatic venous outflow tract is the cause of portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS). Patients with PVT may experience a shorter survival rate compared to those without. The present study aimed to determine the portal vein thrombosis occurrence in Budd-Chiari syndrome patients. Patients and Methods: This cross-sectional study was conducted on 46 Budd-Chiari syndrome patients in Gastroenterology department of DHQ Teaching Hospital and Mufti Mahmood Memorial Hospital, Dera Ismail Khan from November 2021 to October 2022. Written informed consent was taken from each individual. Doppler ultrasonography (colored-pulsed) was used to confirm the PVT and BCS cases. Clinical data, laboratory findings, and radiological data were recorded. SPSS version 26 was used for data analysis. Results: The overall mean age of the BCS patients was 28.34±4.6 years. The prevalence of portal vein thrombosis in BCS patients was 12.8% (n=6). Of the total cases, the incidence of chronic and acute BCS presentation was 42 (91.3%) and 4 (8.7%) respectively. The most prevalent symptoms of BCS were abdominal pain and abdominal enlargement in 38 (82.6%) and 41 (89.1%) respectively. Hepatomegaly and ascites were most prevalent clinical signs found in 36 (78.3%) and 37 (80.4%) respectively. The incidence of esophageal varices, gastric extension, and fundal varices were 32 (69.6%), 4 (8.7%), and 2 (4.3%) respectively. About 21 (45.7%) cases had Portal hypertensive gastropathy (PHG). Conclusion: A higher incidence of PVT was observed in the present study than previously reported. Sociodemographic data and underlying etiology of BCS were not significantly different between patients with and without PVT. Those with PVT were more likely to experience hepatic tenderness, increased white blood cells, and increased direct bilirubin. PVT and other patients had similar Doppler ultrasound findings. Keywords: Portal vein thrombosis, Prevalence, Budd-Chiari syndrome

Study on the prevalence of Portal vein thrombosis and its risk factors in cirrhotic patients in a tertiary care center

Study on the prevalence of Portal vein thrombosis and its risk factors in cirrhotic patients in a tertiary care center

S3216 When to Start Anticoagulation? A Case of Portal Vein Thrombosis in a Post-Partum Cirrhosis Patient With Variceal Bleeding

Introduction: While portal vein thrombosis (PVT) is a relatively rare disease in the general population, the prevalence of PVT in cirrhosis increases in parallel with the severity of cirrhosis. The pathogenesis of PVT in cirrhosis is thought to be multifactorial resulting mainly from alterations in the different components of Virchow’s triad. Case Description/Methods: Here we report a case of a 36-year-old woman with history of alcoholic cirrhosis who presented 2 weeks status post c-section complaining of acute onset abdominal pain, bloating, and nausea with two episodes of hematemesis. Her initial vital signs were unremarkable and hemoglobin was 7.4 gm/dL. Her model for end-stage liver disease (MELD) score was 16. She underwent upper endoscopy (EGD) with successful banding of 3 columns of large varices which showed stigmata of recent bleeding. Patient also underwent diagnostic and therapeutic paracentesis which did not show signs of spontaneous bacterial peritonitis (SBP). However, she did have history of wound dehiscence of her cesarean incision with persistent leakage of serous fluid despite prior negative pressure wound therapy. Therefore, CT abdomen/pelvis was obtained which demonstrated nonocclusive thrombus in the main portal vein extending into both the right and left branches. Due to finding of PVT, MRI was also obtained which showed no evidence of malignancy. As her hemoglobin remained stable ( >7 gm/dL) during hospitalization, she was started on therapeutic low molecular weight heparin (LMWH). Unfortunately, patient was re-admitted five days later for hematemesis and drop in her hemoglobin to 5.6 gm/dL. She received blood products, and repeat EGD showed cratered and superficial esophageal ulcers at the site of prior variceal treatment. Ultimately LMWH was held and resumed after hemoglobin stabilized. Discussion: This case demonstrates the conundrum of if/when to treat PVT in patients with cirrhosis. Current guidelines recommend anticoagulation as the mainstay of PVT treatment. However, this is can be complicated by other sequelae of decompensated cirrhosis such as variceal bleeding. Consequences of non-treatment include further increase in resistance to portal blood thus worsening portal hypertension. In this case, patient’s post-partum status also favors anticoagulation as other society guidelines have recommended anticoagulation with LMWH for postpartum patients with vascular disease of the liver. Therefore, individualized treatment algorithms should be developed and used to guide management.

THU066 - Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease related cirrhossis: a meta-analysis of observational studies

THU066 - Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease related cirrhossis: a meta-analysis of observational studies

Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease: a meta-analysis of observational studies

Introduction: Portal vein thrombosis (PVT) is a common complication of cirrhosis because of significant modification in the hemostatic balance, especially in decompensated stage. Furthermore, patients with non-alcoholic fatty liver disease (NAFLD) related cirrhosis seems to be at higher risk of PVT development than patients with cirrhosis related to other causative factors. Nevertheless, definitively data in favor of an increased rate of PVT in NAFLD are missing. This meta-analysis attempted to estimate the prevalence of PVT in patients with NAFLD.

Portal Vein Thrombosis in Pakistani Population with Hepatocellular Carcinoma – Prevalence and Risk Factors

Introduction: Hepatocellular carcinoma (HCC) is frequently associated with portal vein thrombosis (PVT) with reported incidence ranging from 30 to 40% in different studies. PVT may be associated with poor prognosis, limiting the available treatment options for these patients. The objective of our study was to determine the prevalence and risk factors of PVT in HCC in the Pakistani population. Method: Retrospective analysis was performed on the prospectively collected data from January 2018 to March 2020. All patients with HCC discussed in our weekly multidisciplinary liver clinic during the specified period were reviewed. The patients with PVT were analyzed to determine the frequency and factors associated with PVT. Result: Of 316 patients with HCC discussed in our liver clinic, the prevalence of PVT was 31% (98 patients). The site of thrombosis included the main portal vein in 38(12%) and branch portal vein in 58(18.4%) patients; while 2(0.6%) patients had thrombosis in other systemic veins along with PVT. On univariate analysis, factors associated with PVT included abdominal pain (p=0.047), jaundice (p=0.012), raised alpha-fetoprotein (AFP) levels (p=0.000), deranged bilirubin levels (p=0.004), large tumor size (p=0.000), ascites (p=0.003), higher MELD score (p=0.004) and Child-Pugh classification B or C (p=0.001). On multivariate analysis, larger tumor size (p=0.000), raised AFP level (p=0.036) and higher Child-Pugh class (p=0.008) were significantly associated with PVT in HCC. Conclusion: The prevalence of PVT in our HCC patients is 31%. We identified the factors associated with PVT in our population which may be used for additional screening of high-risk patients.

Study on the prevalence of portal vein thrombosis and its risk factors in cirrhotic patients in a tertiary care center

Background and Aim: Portal vein thrombosis (PVT) is a serious complication in patients with cirrhosis and it can be partial and asymptomatic to complete block leading on to decompensation, variceal bleeding and intestinal infarction. We aimed to study the prevalence and risk factors of PVT in patients with cirrhosis.