Kryssia I Rodriguez-Castro1, Alessandro Vitale2, Mariangela Fadin3, Sarah Shalaby1, Patrizia Zerbinati3, Maria Teresa Sartori4, Stefano Landi5, Irene Pettinari5, Fabio Piscaglia5, Guohong Han6, Patrizia Burra1, Paolo Simioni3, Marco Senzolo1. 1. Departments of Surgery, Oncology and Gastroenterology, Multivisceral Transplant Unit. 2. Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit. 3. Medicine. 4. Clinical Medicine I, Department of Medicine, Padua University Hospital, Padua. 5. Department of Digestive Diseases and Internal Medicine, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 6. Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Abstract
BACKGROUND AND OBJECTIVE: Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics. PATIENTS AND METHODS: Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled. All patients underwent evaluation of coagulation status and thrombophilia screening. Thrombus characteristics and extension were evaluated at baseline and during follow-up. Anticoagulation was continued until recanalization or up to 12 months. Variables correlated with the response to anticoagulation were used to create a predictive score that was validated in an external multicenter cohort. RESULTS: A total of 65 patients were included and had partial PVT in most cases (72%). Treatment with enoxaparin resulted in an overall response rate of 66% (43/65) after a median time of 4.4 months and 76% (33/43) within the first 6 months. At multivariate analysis, efficacy of anticoagulation correlated with the severity of liver disease, complete verus partial PVT, age of the thrombus, and time interval from treatment start (<6 months). The areas under the curve of the statistical model for predicting the response to anticoagulation were 0.84 and 0.76 for the training (n=65) and validation (n=60) cohorts, respectively. CONCLUSION: Early diagnosis and early treatment are key factors for the successful management of PVT in cirrhosis, so that screening of PVT and prompt start of anticoagulant treatment should be mandatory.
BACKGROUND AND OBJECTIVE: Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics. PATIENTS AND METHODS: Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled. All patients underwent evaluation of coagulation status and thrombophilia screening. Thrombus characteristics and extension were evaluated at baseline and during follow-up. Anticoagulation was continued until recanalization or up to 12 months. Variables correlated with the response to anticoagulation were used to create a predictive score that was validated in an external multicenter cohort. RESULTS: A total of 65 patients were included and had partial PVT in most cases (72%). Treatment with enoxaparin resulted in an overall response rate of 66% (43/65) after a median time of 4.4 months and 76% (33/43) within the first 6 months. At multivariate analysis, efficacy of anticoagulation correlated with the severity of liver disease, complete verus partial PVT, age of the thrombus, and time interval from treatment start (<6 months). The areas under the curve of the statistical model for predicting the response to anticoagulation were 0.84 and 0.76 for the training (n=65) and validation (n=60) cohorts, respectively. CONCLUSION: Early diagnosis and early treatment are key factors for the successful management of PVT in cirrhosis, so that screening of PVT and prompt start of anticoagulant treatment should be mandatory.
Authors: Ellen G Driever; Fien A von Meijenfeldt; Jelle Adelmeijer; Robbert J de Haas; Marius C van den Heuvel; Chandrasekaran Nagasami; John W Weisel; Constantino Fondevila; Robert J Porte; Anabel Blasi; Nigel Heaton; Stephen Gregory; Pauline Kane; William Bernal; Yoh Zen; Ton Lisman Journal: Hepatology Date: 2021-12-05 Impact factor: 17.298
Authors: Mariella Faccia; Maria Elena Ainora; Francesca Romana Ponziani; Laura Riccardi; Matteo Garcovich; Antonio Gasbarrini; Maurizio Pompili; Maria Assunta Zocco Journal: World J Gastroenterol Date: 2019-08-21 Impact factor: 5.742