Anticoagulation therapy for recent portal vein thrombosis in a patient with liver cirrhosis suffering from variceal rebleeding

2002 ◽  
Vol 122 (7) ◽  
pp. 2095 ◽  
Author(s):  
Manuel Romero-Gömez ◽  
Reyes Gutierrez-Tous ◽  
David Delgado-Mije
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Vein Thrombosis

scholarly journals Acute Portal Vein Thrombosis Treated with Recombinant Human Soluble Thrombomodulin Combined with Antithrombin III

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Satoshi Nakayama ◽  
Naoya Murashima
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Antithrombin Iii ◽  
Anticoagulation Therapy ◽  
Major Complication ◽  
Recombinant Form ◽  
Soluble Thrombomodulin ◽  
Vein Thrombosis ◽  
Coagulation Therapy

Portal vein thrombosis is a major complication associated with liver cirrhosis. In cirrhotic patients, a decrease in procoagulant and anticoagulant factors and an unstable balance between them is observed, and a relative decrease in the activation of anticoagulant drivers is one of the main causes of portal vein thrombosis (PVT). Herein, we report a case of acute portal thrombosis associated with liver cirrhosis and treated with a recombinant form of soluble thrombomodulin (thrombomodulin alpha, TM-α) in combination with antithrombin III. TM-α was administered in accordance with the dosage and route of administration for disseminated intravascular coagulation therapy and resulted in dissolution of PVT with a gradual decrease in D-dimer levels. No adverse events were observed during the course of treatment. In the future, in addition to conventional anticoagulation therapy using heparin or antivitamin K drugs, novel therapies targeting protein C activation using a recombinant form of soluble thrombomodulin may play an important role in the treatment of acute PVT.

scholarly journals Portal vein thrombosis in patients with liver cirrhosis: Risk factors and clinical presentation

2021 ◽  
Author(s):  
Sondes Bizid ◽  
Houssaina Jlassi ◽  
Maroua Ben Abbes ◽  
Ghanem Mohamed ◽  
Hela Ghedira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Factor V Leiden ◽  
Factor V Leiden Mutation ◽  
Vein Thrombosis ◽  
Increased Risk

Abstract Background:Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. PVT impact on disease progression is not clarified as yet. Anticoagulation therapy is considered effective in this setting, but is associated with potentially bleeding episodes. Aim : to assess the risk factors and clinical impact of non-neoplastic PVT complicating cirrhosis, as well as the treatment profile and its efficacy in clinical practice.Methods:A retrospective monocentric study over a period of 19 years including all patients diagnosed with cirrhosis and non-neoplastic PVT was conducted.Results:A total of 49 patients were enrolled in the present study.The mean age was 60.86±11.61 years old. Chronic viral hepatitis was the most frequent cause of cirrhosis (63.2%). Most of our cases had advanced liver disease (89.9% Child class B/C) with a mean MELD score of 19.27. The risk factors for thrombophilia, inherited or acquired, were: a deficiency in coagulation inhibitors, either isolated or combined (protein S, protein C and antithrombin III) in 19 patients, a heterozygous Factor V Leiden mutation in 2 patients, a heterozygous MTHFR mutation in one patient, an antiphospholipid antibodies syndrome in 2 patients, an essential thrombocythemia in one patient. Anticoagulant therapy was indicated in half of the cases. Multivariate analyses demonstrated that thrombus extension was the only independent predictive factor of portal vein recanalization (p=0.009). During follow-up, progression was observed in 8% of treated patients with anticoagulants versus 12.5% of untreated patients (p=0.12). Our study has shown that anticoagulant treatment is not associated with elevated risk of bleeding or developing other complications. The mean survival was higher in patients treated successfully (38.31 months Vs 23.41 months, p=0.204). Conclusions:Our outcomes confirm that anticoagulation therapy in cirrhotic patients with non-neoplastic PVT is not associated with increased risk of liver disease decompensation, including bleeding.

scholarly journals Cerebellar hemorrhage in patients treated with edoxaban for portal vein thrombosis after hepatobiliary surgery: a report of two cases

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroya Iida ◽  
Toru Miyake ◽  
Masaji Tani ◽  
Takuya Tanaka ◽  
Kayo Kawakami ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Anterior Segment ◽  
Left Lobe ◽  
Ventricular Drainage ◽  
Hepatobiliary Surgery ◽  
Cerebellar Hemorrhage ◽  
Hematoma Evacuation ◽  
Vein Thrombosis

Abstract Background The standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years. Case presentation Case 1 A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection. Case 2 A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery. Conclusions Although edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.

Antiphospholipid Antibodies and Antiphospholipid Syndrome: Role in Portal Vein Thrombosis in Patients With and Without Liver Cirrhosis

2010 ◽  
Vol 17 (4) ◽  
pp. 367-370 ◽  
Author(s):  
Lucio Amitrano ◽  
Paul R. J. Ames ◽  
Maria Anna Guardascione ◽  
Luis R. Lopez ◽  
Antonella Menchise ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Vein Thrombosis
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