scholarly journals Management of Anticoagulation for Portal Vein Thrombosis in Individuals with Cirrhosis: A Systematic Review

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Geneviève Huard ◽  
Marc Bilodeau
Keyword(s):  
Systematic Review ◽  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Current Knowledge ◽  
Vein Thrombosis ◽  
Advantages And Disadvantages ◽  
Risk Of Bleeding ◽  
Coagulation Abnormalities ◽  
Increased Risk

Non-neoplastic portal vein thrombosis (PVT) is an increasingly recognized complication of liver cirrhosis. It is often diagnosed fortuitously and can be either partial or complete. The clinical significance of PVT is not obvious except in some situations such as when patients are on the waiting list for liver transplantation. The only known therapy is anticoagulation which has been shown to permit the disappearance of thrombosis and to prevent further extension. Anticoagulation is a challenging therapy in individuals with liver cirrhosis because of the well-recognized coagulation abnormalities observed in that setting and because of the increased risk of bleeding, especially from gastrointestinal tract caused by portal hypertension. We herein review the current knowledge on that topic in order to highlight the advantages and disadvantages of the currently proposed therapeutic attitudes in face of the diagnosis of PVT in individuals with cirrhosis.

A Systematic Review and Meta-Analysis of Safety and Efficacy for Pre-Procedural Use of Thrombopoietin Receptor Agonists in Hepatic Cirrhosis Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1094-1094
Author(s):  
Kunhwa Kim ◽  
Faustine Ong ◽  
Gabor Varadi ◽  
Sorab Gupta ◽  
Vinicius Machado Jorge
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Statistical Significance ◽  
P Value ◽  
Receptor Agonists ◽  
Vein Thrombosis ◽  
Increased Risk

Introduction Thrombocytopenia is common in liver cirrhosis patients, which often complicates with patients' frequent issue with gastrointestinal bleeding and procedural needs. Based on biologic understanding of decreased thrombopoietin(TPO) level in liver cirrhosis patients, use of TPO agonists in liver cirrhosis have been actively studied. Over the period of time, new studies have come out about 2 FDA-approved TPO agonists, Avatrombopag and Lusutrombopag, for prophylaxis before procedure in liver cirrhosis patients with thrombocytopenia. In the past, there have raised concerns of increased risk of portal vein thrombosis and other thrombotic risks in other agents. In our study, we aimed to study the effectiveness and safety of TPO receptor agonists for pre-procedural use in patients with liver cirrhosis. Study design Study was conducted from August 2018 to July 2019. Previous studies were identified through database searching MEDLINE, CENTRAL, Clinicaltrial.gov and google search. Randomized clinical trials with active treatment arm with TPO receptor agonists in the use of liver cirrhosis patients, with intention of pre-procedural prophylaxis, and having placebo for direct comparisons were included. One of the major exclusions was TPO receptor agonists to increase platelet counts for anti-viral treatment in cirrhosis patients. 14 studies were identified. Studies were reviewed and eligibility was determined by two independent clinically trained researchers. 5 duplicated studies were removed, and in total of 7 studies were included for quantitative and qualitative analysis. Details of studies were collected by 2 independent researchers and compared. When there is a discrepancy, repeat review of the study was conducted. Studies were conducted or published from 2012 to 2018. 1 trial from Eltrombopag, 3 trials from Avatrombopag, and 3 trials from Lusutrombopag were included. Result Characteristics of included studies are summarized in table 1. Our studies found that 5.5(95% CI : 4.35-7.15) times higher risk ratio(RR) of reaching platelet target before procedure compared to placebo. Target platelet number goal was 50,000 to 80,000 depending on the study. Studies showed homogenous result with I-squared was 30.8% and q-statistics of p-value 0.193.(Figure 1) Subgroup analysis by FDA-approved medication of Avatrombopag and Lusutrombopag showed statistically significant higher risk ratio of 4.74(3.36-6.68) and of 5.52(3.65-8.34) each compared to placebo. Risk ratio for preventing platelet transfusion was not able to be calculated with heterogeneity of study with I-square higher than 90%. Lusutrombopag study showed significant benefits (RR 6.33, 95% CI 2.95-13.58) with heterogeneity inside the same medications, which might be explained with different doses in studies. No statistical significance in risk ratio in a study with Avatrombopag. Subgroup analysis limited to phase 3 studies showed risk ratio of preventing transfusion of 2.87(95% CI 2.15-3.82) but heterogeneity with q-statistics of p-value at 0.029. Relative risk for adverse event related to portal vein thrombosis was not statistically significant with RR of 0.99(95% CI : 0.35-2.85) in total of 1,229 patients.(Figure 2) Study result was homogenous result by I-square 0%, q-statistics of p-value 0.794. Other severe adverse events, major bleeding risk, overall thrombosis risk were not statistically significant. Only increased risk without statistical significance was reported in trail with Eltrombopag which was early terminated. Conclusion Our meta-analysis of pre-procedural use of TPO agonist in liver cirrhosis patients showed statistically significant benefit of reaching platelet count goal by 5.58 times with risk ratio, but no benefit of preventing transfusion. Compared to prior studies including use of TPO agonists for Interferon-Ribavirin treatment, meta-analysis limited to pre-procedural use did not show statistically significant increase in portal vein thrombosis. Serious adverse events including thrombosis events and bleeding risk were not statistically significant. Most studies described that portal-vein thrombosis events were often related to high platelet counts about 200,000 and longer use of TPO agonist. In current era with lesser use of Interferon and Ribavirin as an anti-viral therapy, TPO agonists use in setting of pre-procedure mostly with lower platelet targets can be safely used. Disclosures No relevant conflicts of interest to declare.

scholarly journals Exploring the Outcomes of Portal Vein Thrombosis in the Clinical Setting of Cirrhosis, Malignancy, and Intra-abdominal Infections with and without Anticoagulation: A Retrospective 5-Year Study

2017 ◽  
Vol 27 (04) ◽  
pp. 208-212
Author(s):  
Joanne Joseph ◽  
Samuel Chew ◽  
Julie George ◽  
Tay Chin ◽  
Ashish Sule
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Complete Resolution ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Partial Resolution ◽  
Outcomes Measures ◽  
Increased Risk ◽  
Abdominal Infections

AbstractThe aim of this study was to understand the differences in clinical outcomes in portal vein thrombosis (PVT) patients with cirrhosis, malignancy, and abdominal infections, with or without anticoagulation. This study was approved by ethics committee. Data were collected from 2011 to 2016. Patients were classified into three groups: PVT with cirrhosis, malignancy, and infections. Primary outcomes measures collected were clot resolution, bleeding, recurrence, and death. Frequency, means, and percentages were calculated. In total, 30 patients were analyzed in this study. Mean age was 60.8 years (range of 30–91 years). There were 19 (63.3%) males and 11 (36.7%) females with ethnicity: 21 (70.0%) Chinese, 2 (6.7%) Malay, 2 (6.7%) Indian, and 5 (16.7%) other race. Fifteen patients received anticoagulation and 15 did not receive anticoagulation. Of the 15 patients who received anticoagulation, there was complete resolution of thrombus in 5 (33.3%), partial resolution in 1 (6.7%), and no resolution in 9 (60.0%). Of these 15 patients, there was bleeding in 3 (20.0%), there was no recurrence in 9 (60.0%), and 3 (20.0%) died during the period of follow-up. Of the 15 patients who did not receive anticoagulation, there was complete resolution of thrombus in 2 (13.3%), partial resolution in 0 (0.0%), and no resolution in 13 (86.7%). Of these 15 patients, there was bleeding in 0 (0%), there was recurrence in 2 (13.3%), and 6 (40.0%) died during the period of follow-up. Anticoagulation is effective in PVT. It reduces mortality with lower rate of recurrence. However, it is associated with increased risk of bleeding.

scholarly journals A221 CLINICAL CHARACTERISITICS OF PORTAL VEIN THROMBOSIS AMONG AN INPATIENT COHORT WITH CIRRHOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 254-255
Author(s):  
K Dadgar ◽  
E M Kelly
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bleeding Complications ◽  
P Value ◽  
Optimal Management ◽  
Bacterial Peritonitis ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Cirrhotic Patients

Abstract Background Portal vein thrombosis (PVT) has a reported prevalence ranging from 0.6 to 26% in cirrhotic patients and yet optimal management in these patients remains unclear [1]. PVT can lead to poor outcomes including increased risk of bleeding, intestinal injury, and deterioration in liver function. Conversely, treatment of PVT in cirrhotic patients increases their risk of bleeding complications, particularly in patients with known varices. Aims The aim of this study is to better characterize the prevalence and impact of PVT in cirrhotic inpatients. Methods We conducted a retrospective cohort study based on data collected on adult patients admitted to the Ottawa Hospital between January 1, 2011 and December 31, 2015. We included patients with a diagnosis of cirrhosis either before or during index admission. Patients with a radiology report indicating a PVT were compared to those without PVT. Non-Ontario residents were excluded and where there were multiple admissions per patient one admission was randomly selected to be used. Ethics approval was obtained from the Research Ethics Board at the University of Ottawa. Results This study found 34 patients with cirrhosis diagnosed with PVT during their hospitalization (3.73%). Of the patients with PVT, 23 were acute and 11 were chronic based on radiologic appearance. Mean age was similar between groups (PVT: 61.7, SD=9.8; No PVT: 62.3, SD=12.3). The mean Na-MELD was also similar (PVT: 17.6, no PVT: 17.3, p=0.82). Among patients with PVT, 11 patients presented with ascites, 10 with hepatic encephalopathy (HE), 5 with abdominal pain and 5 with an upper GI bleed. Spontaneous bacterial peritonitis (SBP) occurred in 11.76% of patients with PVT as compared to 3% of patients without PVT (p value= 0.006). There also seemed to be a trend towards more HE in the cohort with PVT (20.6% vs 10.7%, p value= 0.07). With regards to screening for varices, 2 patients had an EGD in the 6 months prior to admission, 11 had an EGD on admission, 1 after anticoagulation due to bleeding, and 18 had no screening in the 6 months prior to admission. Twelve patients were treated for PVT, 17 were untreated and 5 did not have documentation about treatment. Of the patients that were not treated, 9 were due to palliative goals of care, 1 due to bleeding, 1 due to thrombocytopenia, 2 due to chronicity on imaging and 4 did not have reasons documented. Conclusions PVT is a known complication of cirrhosis, however the clinical significance and optimal management of patients with PVT is poorly understood. Although prevalence of PVT was low in this cohort, our data suggests some possible association between liver related complications and PVT, including SBP and HE. Further research is needed to determine how to best manage patients with PVT. 1. Garcia-Pagan JC, Valla DC. Portal vein thrombosis: a predictable milestone in cirrhosis? Journal of hepatology. 2009 Oct 1;51(4):632–4. Funding Agencies None

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.

Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis

2019 ◽  
Vol 13 (4) ◽  
pp. 468-481 ◽  
Author(s):  
Xiangbo Xu ◽  
Xiaozhong Guo ◽  
Valerio De Stefano ◽  
Gilberto Silva-Junior ◽  
Hemant Goyal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Vein Thrombosis

scholarly journals Association between Portal Vein Thrombosis and Survival in Non-Liver-Transplant Patients with Liver Cirrhosis: A Systematic Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Xingshun Qi ◽  
Junna Dai ◽  
Man Yang ◽  
Weirong Ren ◽  
Jia Jia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Cirrhosis ◽  
Portal Vein ◽  
Liver Transplant ◽  
Portal Vein Thrombosis ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Vein Thrombosis ◽  
Transplant Patients ◽  
Overall Mortality

A systematic review of the literature was performed to analyze the association between portal vein thrombosis (PVT) and survival in non-liver-transplant patients with liver cirrhosis. PubMed, EMBASE, and Cochrane Library databases were searched for all relevant papers which evaluated the prognostic value of PVT in predicting the survival of liver cirrhosis. Meta-analyses were not conducted because the ways of data expression and lengths of follow-up were heterogeneous among studies. Overall, 13 papers were included. The 5-day, 6-week, and 1-year mortality were investigated in 1, 3, and 1 studies, respectively; and all of them were not significantly different between cirrhotic patient with and without PVT. By comparison, the 3-year mortality was reported in 1 study; and it was significantly increased by the presence of PVT. The overall mortality was analyzed in 5 studies; and the association with overall mortality and PVT was significant in 4 studies, but not in another one. However, as for the cirrhotic patients undergoing surgical or interventional shunts, the overall mortality was not significantly associated with the presence of PVT in 4 studies. In conclusion, the presence of PVT might be associated with the long-term mortality in non-liver-transplant patients with liver cirrhosis, but not with the short-term mortality.

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