Original articleLiver, pancreas, and biliary tractEfficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis
Section snippets
Patients
Patients with cirrhosis and acute/subacute thrombosis or progression of previous thrombosis of the splenoportomesenteric axis attended from June 2003 to September 2010 in 4 tertiary hospitals in Spain (Hospital Clinic, Barcelona; Hospital Ramón y Cajal, Madrid; Hospital General Universitario Gregorio Marañón, Madrid; Hospital Marqués de Valdecilla, Santander) and who received treatment with anticoagulants were included in the study. The decision to start anticoagulation treatment followed the
Patient Characteristics and Extent of Thrombosis at Diagnosis
Fifty-five patients were included and followed up for a median of 19 months (range, 1–68 months) after time zero. The main characteristics at time zero are presented in Table 1. Only 1 patient had a history of thrombosis (a pulmonary embolism).
Diagnosis and extension of thrombosis at time zero were based on data obtained from 1 imaging study of 38 patients (69%), angio-CT scan in 21 patients (38%), angio-MRI in 3 patients (6%), and Doppler ultrasound in 14 patients (25%). Two or more imaging
Discussion
The belief that patients with cirrhosis have a hypocoagulable state has recently been challenged.16, 17, 18, 19, 20 Indeed, the decrease in liver-derived procoagulant factors is usually overcompensated by a decrease in liver-derived anticoagulant factors and by an increase in the procoagulant factors VIII and von Willebrand. Consequently, patients with cirrhosis, especially in Child–Pugh class C,17 present a hypercoagulable rather than hypocoagulable state. Supporting this observation, patients
Acknowledgements
Drs Delgado and Seijo contributed equally to this work.
References (28)
- et al.
Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development
J Hepatol
(2009) - et al.
Comparative analysis of the results of orthotopic liver transplantation in patients with and without portal vein thrombosis
Transplant Proc
(2005) - et al.
Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy
Hepatology
(2000) - et al.
Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation
Clin Gastroenterol Hepatol
(2008) - et al.
An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis
Gastroenterology
(2009) - et al.
Hypercoagulation and thrombophilia in liver disease
J Thromb Haemost
(2008) - et al.
Haemostatic abnormalities in patients with liver disease
J Hepatol
(2002) - et al.
Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis
J Hepatol
(2011) - et al.
Portal vein thrombosis after variceal endoscopic sclerotherapy in cirrhotic patients: role of genetic thrombophilia
Endoscopy
(2002) - et al.
Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation
Gut
(2005)
Correlation of routinely used coagulation parameters and presence of portal vein thrombosis in patients with liver cirrhosis
Hepatol Res
Extrahepatic portal vein thrombosis
Semin Liver Dis
Vascular disorders of the liver
Hepatology
Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome
Transplantation
Cited by (0)
Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by grants from the Ministerio de Educación y Ciencia (SAF-10/17043) and from the Instituto de Salud Carlos III (PI 09/01261). CIBEREHD is funded by the Instituto de Salud Carlos III. M.G.D. has received financial support from the Fundación Banco Bilbao Vizcaya Argentaria. S.S. is supported by Rio Hortega-Instituto de Salud Carlos III.