Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case‐control study

Stine, Jonathan G.; Wang, Jennifer; Shah, Puja; Argo, Curtis K.; Intagliata, Nicolas M.; Uflacker, Andre; Caldwell, Stephen H.; Northup, Patrick G.

doi:10.1111/liv.13500

Cited by 130 publications

(126 citation statements)

References 34 publications

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“…slowdown of the blood flow, hypercoagulation and endothelial damage. In cirrhotic subjects various prothrombotic conditions coexist, especially coagulation alterations, while according to recent studies [2,3] the most important of all is slowdown of the portal circulation.…”

Section: Introductionmentioning

confidence: 99%

Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers

Giannitrapani¹,

Granà²,

Licata³

et al. 2018

Med Princ Pract

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Objective: Nonselective β-blockers (NSBB) are used in liver cirrhosis (LC) to prevent variceal bleeding because they decrease portal pressure. A main risk factor for the development of portal vein thrombosis (PVT) in LC is decreased portal vein inflow velocity. The aim of our study was to examine retrospectively the incidence of PVT and its correlation with the use of β-blockers in a cohort of LC patients. Subjects and Methods: Data from 230 LC patients (90% Child-Pugh class A), who had been followed up for at least 5 years, were reviewed. The diagnosis of PVT was made by ultrasound. The presence of PVT was evaluated with multiple logistic regression analysis where the independent variables were those significant in the univariate analysis. Results: The prevalence of PVT at baseline was 4.5%, and the incidence was 4.3% at 5 years; among the subjects taking β blockers, 46.4% were taking NSBB. A total of 19 PVT cases were found. Grade of esophageal varices (p < 0.01), PLT (p < 0.003), INR (p < 0.03), spleen diameter (p < 0.001) and PLT/spleen ratio (p < 0.0005) were significantly associated with PVT. The use of NSBB indicated a higher risk of PVT compared to selective β-blockers (SBB) (p < 0.05). In logistic regression analysis only the grade of esophageal varices was significant (p < 0.02). Univariate analysis of patients taking β-blockers showed an association of PVT with grade of esophageal varices (p < 0.01), CP class (p < 0.02), AST (p < 0.03), ALT and albumin (p < 0.02), PLT count and PLT/LD (p < 0.03), longitudinal diameter of the spleen (p < 0.005), ascites (p < 0.05), portal vein (p < 0.0001) and NSBB (OR 8.1; 95% CI 1.7–38.8). Conclusion: NSBB seem to play a role in PV thrombogenesis. Further studies are needed, especially in decompensated LC patients.

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Section: Introductionmentioning

confidence: 99%

Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers

Giannitrapani¹,

Granà²,

Licata³

et al. 2018

Med Princ Pract

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“…Results have been inconsistent. Two prospective longitudinal studies and one retrospective case control study did find a significant and independent association between baseline portal vein blood flow velocity and later development of portal vein thrombus. Another prospective study found an association on univariate analysis.…”

Section: Portal Vein Thrombosis In Patients With Cirrhosismentioning

confidence: 90%

“…Currently available epidemiological data indicate that approximately 30% of portal vein thrombi are transient . However, a systematic meta‐analysis emphasized the significant heterogeneity of the different studies analysed . The heterogeneity was probably based on several factors, including different time frames for evaluation, different selection criteria for the study population (Child‐Pugh class, hepatocellular carcinoma, waiting list for liver transplantation or control groups in of retrospective studies on anticoagulation therapy) as well as an evaluation of abstracts vs full papers …”

Section: Portal Vein Thrombosis In Patients With Cirrhosismentioning

confidence: 99%

“…22 However, a systematic meta-analysis emphasized the significant heterogeneity of the different studies analysed. 10 The heterogeneity was probably based on several factors, including different time frames for evaluation, different selection criteria for the study population (Child-Pugh class, hepatocellular carcinoma, waiting list for liver transplantation or control groups in of retrospective studies on anticoagulation therapy) as well as an evaluation of abstracts vs full papers. 7 Limited data suggest that although spontaneously transient portal vein thrombosis is associated with severe liver disease it has no independent impact on outcome and prognosis after adjustment for the severity of portal hypertension and cirrhosis.…”

Section: Transient Portal Vein Thrombosismentioning

confidence: 99%

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Recent developments in the field of vascular liver diseases

Valla

2020

Liver International

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“…PVT is associated with increased risk of hepatic decompensation and inferior overall survival in comparison with patients without PVT, and it may lead to inferior posttransplant outcomes . Many risk factors for PVT development are well established, including reduced portal vein blood flow; however, the impact of hereditary thrombophilia remains controversial . Factor V Leiden (FVL), prothrombin G20210A, and methyltetrahydrofolate reductase (MTHFR) C677T are well‐established risk factors for deep vein thrombosis (DVT) and pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Inherited thrombophilia and portal vein thrombosis in cirrhosis: A systematic review and meta‐analysis

Wang

Bezinover

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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BackgroundPortal vein thrombosis (PVT) is common in cirrhosis. PVT is associated with high morbidity and mortality. Individual reports suggest that PVT occurs more frequently in patients with cirrhosis and inherited thrombophilia. The relationship between cirrhosis, PVT development, and inherited thrombophilia was explored in this study. The aim of the study was to determine whether cirrhotic patients with nontumoral PVT have an increased rate of inherited thrombophilia.MethodsStudies were identified by searching electronic databases up to October 2017 with English language and human subject restrictions. Two independent reviewers screened citations and extracted data. Magnitude of effect was calculated to obtain aggregate estimates of effect size and 95% confidence intervals (CIs). Between‐study variability and heterogeneity were assessed.ResultsOf 2893 citations identified, 9 studies composed of 1929 subjects with cirrhosis were included. The overall prevalence of PVT was 6.5% (n = 125). Both prothrombin G20210A mutation (odds ratio [OR], 2.43; 95% CI, 1.07‐5.53; P = 0.03) and factor V Leiden (FVL) (OR, 1.98; 95% CI, 1.06‐3.68; P = 0.03) were significantly associated with PVT risk. Methyltetrahydrofolate reductase C677T mutation was not associated with increased PVT risk. No heterogeneity or publication bias was observed. One important study with opposite findings could not be included due to lack of primary data.ConclusionsFVL and PTG20210A mutation were associated with increased PVT risk in patients with cirrhosis. This finding reframes the role of inherited thrombophilia in PVT development in patients with cirrhosis. Future prospective studies investigating screening for inherited thrombophilia in all cirrhosis patients with PVT seem warranted.

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Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case‐control study

Abstract: Decreased PV velocity is associated with increased risk of future PVT. Patients with cirrhosis and decreased PV velocity are a high-risk subgroup that warrants further investigation with prospective study.

Cited by 130 publications

References 34 publications

Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers

Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers

Recent developments in the field of vascular liver diseases

Inherited thrombophilia and portal vein thrombosis in cirrhosis: A systematic review and meta‐analysis

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