Elevated International Normalized Ratio: A Risk Factor for Portal Vein Thrombosis in Cirrhotic Patients

Then, Eric O.; Are, Vijay S.; Lopez-Luciano, Michell; Bijjam, Rani; Ofosu, Andrew; Culliford, Andrea; Gaduputi, Vinaya

doi:10.14740/gr1179

Cited by 6 publications

(8 citation statements)

References 36 publications

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“…It is possible that the patient was already at an increased risk of PVT, as cirrhosis is a well-known risk factor. [21][22][23][24] Overall, comparable safety and no excessive platelet increase were observed with lusutrombopag treatment for 7 days regardless of the timing of the discontinuation criteria application. These findings suggest that the role of platelet monitoring in lusutrombopag discontinuation might be limited to helping to ensure treatment safety, such as avoiding thrombosis due to excessive increase of platelets.…”

Section: Discussionmentioning

confidence: 99%

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Is platelet monitoring during 7‐day lusutrombopag treatment necessary in chronic liver disease patients with thrombocytopenia undergoing planned invasive procedures? A phase IIIb open‐label study

Numata

Tanaka

Katsube

et al. 2020

Hepatology Research

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Aim: Lusutrombopag is approved for thrombocytopenia in chronic liver disease patients planned to undergo invasive procedures. In previous clinical studies, lusutrombopag treatment was stopped in patients with an increase in platelet count (PC) of ≥20×10 9 /L from baseline and whose PC was ≥50×10 9 /L (discontinuation criteria). We assessed the influence of platelet monitoring during lusutrombopag treatment in lusutrombopag naïve patients. Methods: In this open label study, Child-Pugh class A and B (A/B) patients were enrolled and treated with lusutrombopag (3 mg/day) for 7 days. In the treatment naïve A/B 1 group, the discontinuation criteria were applied on day 6. In the treatment naïve A/B 2 group, the criteria were not applied. In a non naïve A/B group, the criteria were applied on days 3 and 5-7. The main efficacy end point was the proportion of patients without platelet transfusion (PT) before the primary invasive procedure.

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Section: Discussionmentioning

confidence: 99%

“…Notably, the case of PVT in A/B‐2 was the only severe and serious TEAE considered potentially related to the study drug. It is possible that the patient was already at an increased risk of PVT, as cirrhosis is a well‐known risk factor 21–24 …”

Section: Discussionmentioning

confidence: 99%

Is platelet monitoring during 7‐day lusutrombopag treatment necessary in chronic liver disease patients with thrombocytopenia undergoing planned invasive procedures? A phase IIIb open‐label study

Numata

Tanaka

Katsube

et al. 2020

Hepatology Research

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“…Thus, we considered the possibility of a correlation between blood platelet count and PVT volume. Some reports indicated that the increased risk of PVT in cirrhosis is associated with decreased liver function (Child–Pugh score B/C) [ 7 ], low serum albumin [ 24 ], and increased prothrombin time [ 25 ]. However, these factors had no significant impact on the PVT volume in our study.…”

Section: Discussionmentioning

confidence: 99%

“…However, for cirrhosis patients who had undergone splenectomy, the incidence of PVT after surgery was 37.7% (49/130), and an increased platelet count has been described as a risk factor [ 25 ]. Another report also revealed that the platelet count was significantly higher in the PVT group (mean platelet count, 399.3 × 10 9 /L) than in the non-PVT group (mean platelet count, 296.9 × 10 9 /L) after laparoscopic splenectomy [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Investigation of Thrombosis Volume, Anticoagulants, and Recurrence Factors in Portal Vein Thrombosis with Cirrhosis

Suda

Takatori

Hayashi

et al. 2020

Life

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This retrospective study investigated factors influencing the portal vein thrombosis (PVT) volume and recurrence in 52 cirrhosis patients with PVT from November 2008 to September 2018. All patients were treated with danaparoid sodium with or without additional antithrombin III. Blood platelet counts significantly correlated with the PVT volume (r2 = 0.17; P < 0.01). Computed tomography confirmed recurrence as PVT aggravation was reported in 43 patients, with ≥50% PVT volume reduction following anticoagulation therapy. In 43 patients, recurrence significantly correlated with the pretreatment PVT volume (P = 0.019). Factors influencing recurrence included a Child–Pugh score >8 (P = 0.049) and fibrosis index ≤7.0 based on four factors (FIB-4) (P = 0.048). Moreover, the relationship between recurrence and correlating factors showed that 15 patients who received warfarin experienced recurrence more often when Child–Pugh scores were >8 (P = 0.023), regardless of maintenance treatment. For patients who did not receive warfarin, a PVT volume ≥3.0 mL significantly influenced recurrence (P = 0.039). Therefore, the platelet count influences the PVT volume. The pretreatment PVT volume correlated with recurrence after anticoagulation therapy. According to the Kaplan–Meier curve, risk factors for PVT recurrence after anticoagulation therapy included Child–Pugh scores >8 and FIB-4 ≤7.0. Therefore, the FIB-4 is a unique factor that shows trends opposing other liver function markers.

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“…In our study, hepatoduodenal ligament massage prevented a reduction in portal vein flow, decreasing the risk of portal vein thrombosis after hepatectomy. Portal vein thrombosis affects the coagulation system, especially PT % [21]. In the massage group, the PT % was higher than that in the nonmassage group after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Massage of the Hepatoduodenal Ligament Recovers Portal Vein Flow Immediately After the Pringle Maneuver in Hepatectomy

et al. 2020

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Background The Pringle maneuver is often used in liver surgery to minimize bleeding during liver transection. Many authors have demonstrated that intermittent use of the Pringle maneuver is safe and effective when performed appropriately. However, some studies have reported that the Pringle maneuver is a significant risk factor for portal vein thrombosis. In this study, we evaluated the effectiveness of portal vein flow after the Pringle maneuver and the impact that massaging the hepatoduodenal ligament after the Pringle maneuver has on portal vein flow. Materials and Methods Patients treated with the Pringle maneuver for hepatectomies performed to treat hepatic disease at our hospital between August 2014 and March 2019 were included in the study (N = 101). We divided these patients into two groups, a massage group and nonmassage group. We measured portal vein blood flow with ultrasonography before and after clamping of the hepatoduodenal ligament. We also evaluated laboratory data after the hepatectomy. Results Portal vein flow was significantly lower after the Pringle maneuver than before clamping of the hepatoduodenal ligament. The portal vein flow after the Pringle maneuver was improved following massage of the hepatoduodenal ligament. After hepatectomy, serum prothrombin time was significantly higher and serum C-reactive protein was significantly lower in the massage group than in the nonmassage group. Conclusion Massaging the hepatoduodenal ligament after the Pringle maneuver is recommended in order to quickly recover portal vein flow during hepatectomy and to improve coagulability.

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Elevated International Normalized Ratio: A Risk Factor for Portal Vein Thrombosis in Cirrhotic Patients

Cited by 6 publications

References 36 publications

Is platelet monitoring during 7‐day lusutrombopag treatment necessary in chronic liver disease patients with thrombocytopenia undergoing planned invasive procedures? A phase IIIb open‐label study

Is platelet monitoring during 7‐day lusutrombopag treatment necessary in chronic liver disease patients with thrombocytopenia undergoing planned invasive procedures? A phase IIIb open‐label study

Investigation of Thrombosis Volume, Anticoagulants, and Recurrence Factors in Portal Vein Thrombosis with Cirrhosis

Massage of the Hepatoduodenal Ligament Recovers Portal Vein Flow Immediately After the Pringle Maneuver in Hepatectomy

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