Vincenzo La Mura1,2, Armando Tripodi3, Giulia Tosetti1, Flaminia Cavallaro1, Veena Chantarangkul3, Massimo Colombo1, Massimo Primignani1. 1. Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Maggiore Hospital Foundation, University of Milan, Milan, Italy. 2. Internal Medicine, IRCCS San Donato, Department of Biomedical Sciences for Health, University of Milan, Italy. 3. Department of Clinical Sciences and Community Health, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Hospital Foundation, University of Milan, Milan, Italy.
Abstract
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is frequently observed in cirrhosis and may be a clinically important complication. In vitro assays for endogenous thrombin potential (ETP) demonstrated that in cirrhosis plasma has intrinsic resistance to the anticoagulant action of thrombomodulin (TM-R). This study retrospectively explores the association of TM-R with de novo PVT and its clinical impact on cirrhosis. METHODS: Fifty-three patients with cirrhosis were tested for ETP-ratio with/without thrombomodulin. Clinical, endoscopic variables, presence/absence of PVT by Doppler-US and/or CT examination were collected at baseline and up to 4 years from baseline. The de novo PVT was the primary clinical end-point. Portal hypertension (PHT)-related complications and transplantation free survival were secondary end-points. ETP-ratio higher than the 95° percentile of the distribution in 173 healthy controls defined TM-R. RESULTS: During 48 months of follow-up, 11 patients developed de novo PVT, with preference for the 36 patients with TM-R after adjusting for Child-Pugh class (HR: 8.354; 90%CI:1.475 - 47.305; P = 0.009). Seventeen patients experienced PHT-related complications, 23 either died or underwent liver transplantation. PHT complications and transplantation free survival were associated with TM-R, but were independently predicted by Child-Pugh class, only. Same results were obtained by considering the MELD score. CONCLUSIONS: Owing to PVT results from the pro-coagulant imbalance occurring in patients with advanced cirrhosis, TM-R might serve as a predictor and could possibly be a biological mediator of adverse outcome in patients with advanced cirrhosis.
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is frequently observed in cirrhosis and may be a clinically important complication. In vitro assays for endogenous thrombin potential (ETP) demonstrated that in cirrhosis plasma has intrinsic resistance to the anticoagulant action of thrombomodulin (TM-R). This study retrospectively explores the association of TM-R with de novo PVT and its clinical impact on cirrhosis. METHODS: Fifty-three patients with cirrhosis were tested for ETP-ratio with/without thrombomodulin. Clinical, endoscopic variables, presence/absence of PVT by Doppler-US and/or CT examination were collected at baseline and up to 4 years from baseline. The de novo PVT was the primary clinical end-point. Portal hypertension (PHT)-related complications and transplantation free survival were secondary end-points. ETP-ratio higher than the 95° percentile of the distribution in 173 healthy controls defined TM-R. RESULTS: During 48 months of follow-up, 11 patients developed de novo PVT, with preference for the 36 patients with TM-R after adjusting for Child-Pugh class (HR: 8.354; 90%CI:1.475 - 47.305; P = 0.009). Seventeen patients experienced PHT-related complications, 23 either died or underwent liver transplantation. PHT complications and transplantation free survival were associated with TM-R, but were independently predicted by Child-Pugh class, only. Same results were obtained by considering the MELD score. CONCLUSIONS: Owing to PVT results from the pro-coagulant imbalance occurring in patients with advanced cirrhosis, TM-R might serve as a predictor and could possibly be a biological mediator of adverse outcome in patients with advanced cirrhosis.
Authors: Maxime G Zermatten; Montserrat Fraga; Debora Bertaggia Calderara; Alessandro Aliotta; Darius Moradpour; Lorenzo Alberio Journal: JHEP Rep Date: 2020-05-11
Authors: Bernhard Scheiner; Patrick G Northup; Anselm B Gruber; Georg Semmler; Gerda Leitner; Peter Quehenberger; Johannes Thaler; Cihan Ay; Michael Trauner; Thomas Reiberger; Ton Lisman; Mattias Mandorfer Journal: Liver Int Date: 2020-03-04 Impact factor: 5.828
Authors: Marco Senzolo; Nicoletta Riva; Francesco Dentali; Kryssia Rodriguez-Castro; Maria Teresa Sartori; Soo-Mee Bang; Ida Martinelli; Sam Schulman; Adriano Alatri; Jan Beyer-Westendorf; Matteo Nicola Dario Di Minno; Walter Ageno Journal: Clin Transl Gastroenterol Date: 2018-08-15 Impact factor: 4.488