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Karasu, Zeki; Gürakar, Ahmet; Kerwin, B.; Hülagü, Saadettin; Jazzar, A.; McFadden, R; Nour, Bakr; Sebastián, Anthony; Cassidy, Francis P.; Stokes, Ken; Thiel, David Van; Wright, Harlan I.

doi:10.1023/a:1005694617983

Cited by 37 publications

(5 citation statements)

References 42 publications

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“…However when the platelet count was compared before and after TIPS placement in the subset of patients with clinically significant thrombocytopenia (≤100 000), the changes were slightly more pronounced but still not statistically significant (6.8x10 3 and 10.8x10 3 ; P values 0.09 and 0.18, respectively). This is in accordance with the prior studies that did not demonstrate a significant increase in platelet count after TIPS placement [ 5 , 6 ] and suggests that the pathogenesis of thrombocytopenia in cirrhotic patients is multifactorial and cannot be justified only by portal hypertension and hypersplenism [ 4 ]. An alternative explanation is that TIPS is unable to release sequestered platelets in the spleen secondary to portal hypertension and hypersplenism [ 5 ].…”

Section: Discussionsupporting

confidence: 92%

“…The pathogenesis of thrombocytopenia in cirrhotic patients is controversial and probably multifactorial including hypersplenism [ 3 ]. The effect of placement of TIPS on platelet count in thrombocytopenic cirrhotic patients is controversial with some showing an increase in platelet count after TIPS placement [ 4 ], while others failed to demonstrate such a relationship [ 5 , 6 ]. Portal pressure gradient (PPG) <12 mmHg after TIPS placement has been reported as the only predictor of increase in platelet count [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt

Ansari-Gilani

Tonekaboni

Nakamoto

et al. 2016

Gastroenterol. Rep.

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ObjectivePortal pressure gradient (PPG) after transjugular intrahepatic portosystemic shunt (TIPS) <12 mmHg has been reported as the only factor predictive of increase in platelet count. As flow velocities measured on Doppler ultrasound are related to pressure gradient based on the Bernoulli equation, we used this parameter to predict increased platelet count after TIPS placement.MethodsA total of 161 consecutive patients who underwent TIPS placement entered this retrospective study. The platelet count was measured before, one week after and one month after TIPS placement. Clinically significant thrombocytopenia was defined as platelet count ≤100 000. Pre- and post-TIPS PPGs were measured. The velocity of blood flow in the proximal, mid and distal TIPS stent was measured using Doppler ultrasound, and the difference in the highest and lowest measured velocity was entitled flow velocity gradient (FVG), which was considered normal when ≤100 cm/s.ResultsIn 121 patients with pre-TIPS thrombocytopenia, the mean platelet count one week and one month after TIPS placement increased 25.7 x 103 and 35.0 x 103 in 90 patients with PPG≤12 mmHg (P=0.028 and P=0.015), while there was no significant change in platelet count in patients with a PPG >12 mmHg (P=0.098 and P=0.075). Platelets increased significantly when FVG≤ 100 cm/s (n=95) vs FVG >100 cm/s (n=26) one week (37.0x103vs 11.0x103; P = 0.005 vs 0.07) and one month after TIPS placement (17.0x103vs 5.2x103; P = 0.01 vs 0.21).ConclusionFVG >100 cm/s is not associated with increase in post-TIPS platelet count. On the other hand, findings suggestive of proper TIPS function (FVG ≤100 cm/s and PPG≤ 12 mmHg) predict a significant increase in post-TIPS platelet count.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt

Ansari-Gilani

Tonekaboni

Nakamoto

et al. 2016

Gastroenterol. Rep.

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“…It is reported[31] that after TIPS treatment, hypersplenism is relieved due to decreased PV pressure and splenic blood flow, which can improve quality of life. However, there are still some patients with hypersplenism with no satisfactory outcome of treatments, including partial splenic arterial embolization, which can improve the symptoms of hypersplenism[32,33]. In patients with cirrhosis who are prone to PVT, which can lead to difficulty with TIPS creation and stent stenosis or occlusion, we suggest that splenectomy should be considered carefully.…”

Section: Discussionmentioning

confidence: 99%

Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency

Dong¹,

Luo²,

Zheng³

et al. 2019

WJCC

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BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension. TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s. Although TIPS has good therapeutic effects on the formation of PVT, the effect of PVT on TIPS stenting has rarely been reported. Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT, which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIMTo investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODSFour hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis. Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197). The incidence of PVT before TIPS was compared between the two groups. After TIPS placement, primary patency rate was compared using Kaplan–Meier analysis at 3, 6, 9 and 12 mo, and 2 and 3 years. The clinical outcomes were analyzed.RESULTSBefore TIPS procedure, the incidence of PVT in group A was lower than in group B (P = 0.003), and TIPS technical success rate in group A was higher than in group B (P = 0.016). The primary patency rate in group A tended to be higher than in group B at 3, 6, 9 and 12 mo, 2 years and 3 years (P = 0.006, P = 0.011, P = 0.023, P = 0.032, P = 0.037 and P = 0.028, respectively). Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001), 6 mo (P = 0.003 and P = 0.005), 9 mo (P = 0.005 and P = 0.012), 12 mo (P = 0.008 and P = 0.024), 2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017), respectively. During 3-years follow-up, the 1-, 2- and 3-year survival rate in group A were higher than in group B (P = 0.008, P = 0.021, P = 0.018, respectively), but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSIONPatients with prior splenectomy have a high incidence of PVT, which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.

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“…They concluded an unpredictable effect on platelet counts in cirrhotic patients with no observable consistent increase in platelet volume [11]. However, of note, this study only documented one pre-TIPS platelet count reading and one reading post-TIPS and likely based their conclusions on insufficient data evidence as it is widely acknowledged that platelet counts can greatly vary daily even in a healthy individual.…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 81%

Thrombocytopenia in Chronic Liver Disease: Challenges and Treatment Strategies

Desai¹,

Subramanian²

2021

Cureus

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Thrombocytopenia is a common hematologic complication seen in patients with chronic liver disease (CLD). The pathophysiology of thrombocytopenia in CLD is multifactorial, primarily stemming from platelet sequestration and decreased platelet production. This review focuses on the pathophysiology and current treatment options in the treatment of thrombocytopenia in chronic liver disease. While platelet transfusions are the gold standard of treatment, considerations ought to be given to CLD patients who can benefit from transjugular intrahepatic portosystemic shunt and splenic artery embolization. Finally, the recent approval of thrombopoietin receptor agonists for use in CLD patients paves a way for a safe and effective alternative method of improving platelet levels and reducing the need for recurrent platelet transfusions.

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Cited by 37 publications

References 42 publications

Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt

Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt

Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency

Thrombocytopenia in Chronic Liver Disease: Challenges and Treatment Strategies

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