Impact of Antithrombin III Concentrates on Portal Vein Thrombosis After Splenectomy in Patients With Liver Cirrhosis and Hypersplenism

Kawanaka, Hirofumi; Akahoshi, Tomohiko; Kinjo, Nao; Konishi, K.; Yoshida, Daisuke; Anegawa, Go; Yamaguchi, Shohei; Uehara, Hideo; Hashimoto, Noriyuki; Tsutsumi, Norifumi; Tomikawa, Morimasa; Maehara, Yoshihiko

doi:10.1097/sla.0b013e3181bdf8ad

Cited by 94 publications

(84 citation statements)

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“…Postoperative dynamic CT should be planned approximately 1 week after splenectomy for early detection of PSVT. Kawanaka et al [24] reported that preoperative antithrombin (AT)-III activity was the most important predictive factor for PVT, and that treatment with AT-III concentrates is likely to prevent the development of PSVT. In this study, we have shown that preoperative AT-III activity was not associated with postoperative PSVT.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy in Chronic Hepatic Disorders: Portal Vein Thrombosis and Improvement of Liver Function

et al. 2011

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Background: Splenectomy is gaining increasing importance for cirrhotic patients with hypersplenism. However, its safety and efficacy for patients with chronic liver disease remain unclear. Methods: We retrospectively examined the medical records of 38 consecutive cirrhotic patients who underwent splenectomy or simultaneous hepatectomy and splenectomy for hepatocellular carcinoma. Results: White blood cell and platelet counts significantly increased 3 months after splenectomy. Serum levels of total bilirubin and prothrombin time significantly improved 1 year after splenectomy. Interferon therapy was administered to 25 patients after splenectomy. A sustained viral response was achieved in 8 patients (42%). The total incidence of portal or splenic vein thrombosis (PSVT) detected by postoperative dynamic computed tomography was 13/38 (34.2%). Multivariate analysis revealed preoperative spleen volume (SV) to be the sole independent predictor of postoperative PSVT. Receiver-operator characteristic curve analysis showed that a cut-off SV of 450 ml corresponded to a sensitivity of 85% and a specificity of 56%. Conclusions: Splenectomy improved the liver function and facilitated effective interferon therapy in cirrhotic patients with hypersplenism, although preoperative SV was frequently associated with postoperative PSVT.

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Section: Discussionmentioning

confidence: 99%

Splenectomy in Chronic Hepatic Disorders: Portal Vein Thrombosis and Improvement of Liver Function

et al. 2011

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“…Portal thrombosis was treated with anticoagulants according to our protocol. The prevalence of portal thrombosis in patients with no prophylactic anticoagulation, with prophylactic anticoagulation using warfarin potassium, and prophylactic anticoagulation using danaparoid sodium and warfarin potassium were 33.3% (2/6 patients), 16.7% (4/24 patients), and 6.3% (1/16 patients), respectively. Bacterial infections and ascites were successfully treated with antibiotics and diuretics, respectively.…”

Section: Complications After Splenectomymentioning

confidence: 99%

“…However, it is not clear whether splenectomy can improve the overall outcome and survival of such patients. Furthermore, major life-threatening complications in such patients include overwhelming postsplenectomy infection associated with a high mortality rate and a high incidence of portal thrombosis [15,16]. Hence, the debate continues as to whether splenectomy worsens or improves patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

et al. 2013

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Summary: Splenectomy may be a treatment option in hepatocellular carcinoma (HCC) and cirrhosis when there is no potential donor for liver transplantation. We retrospectively investigated the long-term outcome of splenectomy on survival in advanced cirrhotic patients with HCC and thrombocytopenia. Between 1999 and 2009, 46 cirrhotic patients with thrombocytopenia (Child-Pugh class B or C) who underwent splenectomy for the simultaneous or secondary treatment of HCC at our institute were evaluated. The 1-, 3-, and 5-year survival rates were 93.5, 76.0, and 37.9%, respectively. Splenectomy resulted in a significant reduction in mean portal venous pressure from 21.2 to 16.8 mmHg and improvements in liver function tests such as total bilirubin, prothrombin time, platelet count, Child-Pugh score for 3 years, and albumin for 2 years. The mean frequency of treatment for HCC recurrence after surgery was 3.0 times (range 1-11). Seven patients out of 16 scheduled for Interferon (IFN) therapy after surgery achieved a sustained virological response (SVR). Multivariate analysis identified SVR after IFN therapy as an independent significant prognostic factor (Hazard ratio 0.18, 95%CI 0.03-0.65, P=0.006). Postoperative complications including liver failure (n=1), portal thrombosis (n=7), ascites (n=5), and bacterial infections (n=4) were observed in 14 patients (30%). Splenectomy can be a feasible supportive therapy for the continuation of anticancer therapy and completion of IFN therapy based on improvements in liver function and thrombocytopenia with minimum complications in patients with HCC and advanced cirrhosis with no potential donor.

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“…The administration of antithrombin Ⅲ (AT-Ⅲ) could be an attractive alternative to PVT in cirrhosis. Kawanaka et al [83] demonstrated that the low AT-Ⅲ activity and further decreases in this activity are associated with PVT after splenectomy in patients with cirrhosis and that treatment with AT-Ⅲ concentrates is likely to prevent the development of PVT in these patients.…”

Section: Treatmentmentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis

Kinjo¹,

Kawanaka²,

Akahoshi³

et al. 2014

WJH

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Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Portal vein thrombosis; Liver cirrhosis; Thrombophilic factors; Anticoagulation; Splenectomy Core tip: Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis; however, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions. The understanding and information on the management of PVT in cirrhosis are incomplete. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.

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Impact of Antithrombin III Concentrates on Portal Vein Thrombosis After Splenectomy in Patients With Liver Cirrhosis and Hypersplenism

Abstract: These results demonstrate that low AT-III activity and further decreases in this activity are associated with PVT after splenectomy in cirrhotic patients, and that treatment with AT-III concentrates is likely to prevent the development of PVT in these patients.

Cited by 94 publications

References 46 publications

Splenectomy in Chronic Hepatic Disorders: Portal Vein Thrombosis and Improvement of Liver Function

Splenectomy in Chronic Hepatic Disorders: Portal Vein Thrombosis and Improvement of Liver Function

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

Portal vein thrombosis in liver cirrhosis

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