Theresa Bucsics1,2, Katharina Lampichler3, Constantin Vierziger4, Maria Schoder3, Florian Wolf3, David Bauer1,2, Benedikt Simbrunner1,2,5, Lukas Hartl1,2, Mathias Jachs1,2, Bernhard Scheiner1,2, Michael Trauner2, Thomas Gruenberger4, Franz Karnel6, Mattias Mandorfer1,2, Thomas Reiberger7,8,9. 1. Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 2. Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 3. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 4. Department of Surgery, Hepato-Pancreato-Biliary Center, Health Network Vienna and Sigmund Freud Private University, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria. 5. Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 6. Department of Radiology, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria. 7. Vienna Hepatic Hemodynamic Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. thomas.reiberger@meduniwien.ac.at. 8. Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. thomas.reiberger@meduniwien.ac.at. 9. Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. thomas.reiberger@meduniwien.ac.at.
Abstract
BACKGROUND: Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia. AIMS: Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC). METHODS: Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS. RESULTS: One hundred ninety-two patients (male: 72.4%, age: 56 ± 10 years; MELD: 12.1 ± 3.6) underwent TIPS implantation. Higher-grade (≥ G2) thrombocytopenia (PLT < 100 G/L) was present in 54 (28.7%), ≥ G2 anemia (Hb < 10 g/dL) in 57 (29.7%), and ≥ G2 leukopenia (WBC < 2 G/L) in 3 (1.6%) patients pre-TIPS, respectively. Resolution of ≥ G2 thrombocytopenia, anemia, and leukopenia occurred in 24/55 (43.6%), 23/57 (40.4%), and 2/3 (66.7%), respectively. Similar results were also observed in the subgroup of patients without 'bleeding' TIPS-indication, with improvements of G ≥ 2 thrombocytopenia and of G ≥ 2 anemia in 19.8% and 10.2% of patients after TIPS, respectively. CONCLUSIONS: Thrombocytopenia, anemia, and leukopenia frequently improved after TIPS. Therefore, moderate- to higher-grade thrombocytopenia should not be regarded as a contraindication against TIPS, but rather be considered in case of severe thrombocytopenia-particularly prior to surgery or interventions.
BACKGROUND: Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia. AIMS: Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC). METHODS: Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS. RESULTS: One hundred ninety-two patients (male: 72.4%, age: 56 ± 10 years; MELD: 12.1 ± 3.6) underwent TIPS implantation. Higher-grade (≥ G2) thrombocytopenia (PLT < 100 G/L) was present in 54 (28.7%), ≥ G2 anemia (Hb < 10 g/dL) in 57 (29.7%), and ≥ G2 leukopenia (WBC < 2 G/L) in 3 (1.6%) patients pre-TIPS, respectively. Resolution of ≥ G2 thrombocytopenia, anemia, and leukopenia occurred in 24/55 (43.6%), 23/57 (40.4%), and 2/3 (66.7%), respectively. Similar results were also observed in the subgroup of patients without 'bleeding' TIPS-indication, with improvements of G ≥ 2 thrombocytopenia and of G ≥ 2 anemia in 19.8% and 10.2% of patients after TIPS, respectively. CONCLUSIONS: Thrombocytopenia, anemia, and leukopenia frequently improved after TIPS. Therefore, moderate- to higher-grade thrombocytopenia should not be regarded as a contraindication against TIPS, but rather be considered in case of severe thrombocytopenia-particularly prior to surgery or interventions.
Authors: Amir A Qamar; Norman D Grace; Roberto J Groszmann; Guadalupe Garcia-Tsao; Jaime Bosch; Andrew K Burroughs; Cristina Ripoll; Rie Maurer; Ramon Planas; Angels Escorsell; Juan Carlos Garcia-Pagan; David Patch; Daniel S Matloff; Robert Makuch; Gabriel Rendon Journal: Clin Gastroenterol Hepatol Date: 2009-03-10 Impact factor: 11.382
Authors: Bernhard Scheiner; Georg Semmler; Florian Maurer; Philipp Schwabl; Theresa A Bucsics; Rafael Paternostro; David Bauer; Benedikt Simbrunner; Michael Trauner; Mattias Mandorfer; Thomas Reiberger Journal: Liver Int Date: 2019-09-13 Impact factor: 5.828
Authors: Nikolaus Pfisterer; Florian Riedl; Thomas Pachofszky; Michael Gschwantler; Kurt König; Benjamin Schuster; Mattias Mandorfer; Irina Gessl; Constanze Illiasch; Eva-Maria Fuchs; Lukas Unger; Werner Dolak; Andreas Maieron; Ludwig Kramer; Christian Madl; Michael Trauner; Thomas Reiberger Journal: Liver Int Date: 2018-10-17 Impact factor: 5.828