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

Abstract

The 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.

Keywords

thrombophilia - portal vein thrombosis - anticoagulation - low molecular weight heparin

• References

• 1 Amitrano L, Guardascione MA, Brancaccio V. , et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40 (05) 736-741
• 2 Parikh S, Shah R, Kapoor P. Portal vein thrombosis. Am J Med 2010; 123 (02) 111-119
• 3 Condat B, Pessione F, Hillaire S. , et al. Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 2001; 120 (02) 490-497
• 4 Sule A, Borja A, Chin TJ. Progression of thrombus in portal vein, superior mesenteric vein, and splenic vein even on anticoagulation in a patient with ascending colonic malignancy with liver metastasis: portal vein thrombosis versus portal vein tumor thrombosis. Int J Angiol 2016; 25 (05) e97-e99
• 5 Qi X, De Stefano V, Li H, Dai J, Guo X, Fan D. Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Eur J Intern Med 2015; 26 (01) 23-29
• 6 Englesbe MJ, Kubus J, Muhammad W. , et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010; 16 (01) 83-90
• 7 Turnes J, García-Pagán JC, González M. , et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
• 8 Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32 (03) 466-470
• 9 Huard G, Bilodeau M. Management of anticoagulation for portal vein thrombosis in individuals with cirrhosis: a systematic review. Int J Hepatol 2012; 2012: 672986
• 10 Amitrano L, Guardascione MA, Menchise A. , et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol 2010; 44 (06) 448-451
• 11 Villa E, Cammà C, Marietta M. , et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143 (05) 1253-60.e1 , 4
• 12 Plessier A, Darwish-Murad S, Hernandez-Guerra M. , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (01) 210-218
• 13 Tateishi A, Mitsui H, Oki T. , et al. Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. J Gastroenterol Hepatol 2001; 16 (12) 1429-1433
• 14 Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR. Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review. World J Surg 2011; 35 (11) 2510-2520
• 15 Sheen CL, Lamparelli H, Milne A, Green I, Ramage JK. Clinical features, diagnosis and outcome of acute portal vein thrombosis. QJM 2000; 93 (08) 531-534
• 16 Kocher G, Himmelmann A. Portal vein thrombosis (PVT): a study of 20 non-cirrhotic cases. Swiss Med Wkly 2005; 135 (25-26): 372-376
• 17 Tsochatzis EA, Senzolo M, Germani G, Gatt A, Burroughs AK. Systematic review: portal vein thrombosis in cirrhosis. Aliment Pharmacol Ther 2010; 31 (03) 366-374
• 18 Manzano-Robleda MdelC, Barranco-Fragoso B, Uribe M, Méndez-Sánchez N. Portal vein thrombosis: what is new?. Ann Hepatol 2015; 14 (01) 20-27
• 19 Kinjo N, Kawanaka H, Akahoshi T. , et al. Portal vein thrombosis in liver cirrhosis. World J Hepatol 2014; 6 (02) 64-71
• 20 Joh JH, Kim DI. Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 2005; 29 (02) 204-208
• 21 Webster GJM, Burroughs AK, Riordan SM. Review article: portal vein thrombosis -- new insights into aetiology and management. Aliment Pharmacol Ther 2005; 21 (01) 1-9
• 22 Park WS, Kim HI, Jeon BJ, Kim SH, Lee SO. Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis?. World J Gastroenterol 2012; 18 (42) 6168-6171