Management of Anticoagulation for Portal Vein Thrombosis in Individuals with Cirrhosis: A Systematic Review

Huard, Geneviève; Bilodeau, Marc

doi:10.1155/2012/672986

Cited by 42 publications

(29 citation statements)

References 29 publications

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“…Reviewing the limited studies reporting use of anticoagulation for PVT in patients with cirrhosis, complete recanalization has been described in 33%-45% while partial PV recanalization is observed in 15%-35% of cases 3,58,59 ( Table 2). In a study by Senzolo et al prospectively enrolling 56 individuals (35 treated and 21 controls) complete recanalization was achieved in 36% and partial recanalization in 27% individuals, after a mean of 5.5 months therapy with low molecular weight heparin (LMWH).…”

Section: Anticoagulant Therapymentioning

confidence: 99%

“…60 In most studies, recanalization is uncommon in patients with complete thrombosis, but anticoagulation still prevented the extension of the thrombus. 3,[58][59][60] An important objective in the management of PVT in cirrhotic patients awaiting liver transplantation is to achieve recanalization so that conventional end-to-end portal vein anastomosis is surgically possible. Another objective is to prevent extension of the thrombus to the splenic and superior mesenteric vein, since these veins can also be used to restore portal flow to the graft in case the main PV is thrombosed.…”

Section: Anticoagulant Therapymentioning

confidence: 99%

“…61 Monitoring of anti-Xa activity to guide therapy is unreliable in cirrhosis. 59,61,62 The primary problem with VKA is determination of adequate anticoagulation in patient with cirrhosis who already have altered coagulation and abnormal prothrombin time. Most studies have targeted an INR of 2-3.…”

Section: Choice Of Anticoagulationmentioning

confidence: 99%

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Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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Section: Anticoagulant Therapymentioning

confidence: 99%

Section: Anticoagulant Therapymentioning

confidence: 99%

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Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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“…Rethrombosis after complete recanalization occurred in 38.5 % of patients after the stopping of anticoagulation [219]. Benefits of continuous anticoagulation are expected in patients awaiting liver transplant with a MELD score greater than 15 and PVT with extension to the superior mesenteric vein [220].…”

Section: Portal Vein Thrombosismentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…There is a potential risk of further lowering of protein C and they are associated with extensive drug interactions. [22][23][24][25] The aims of anticoagulation are to achieve recanalization of the portal vein and to prevent extension of the thrombus to the splenic and superior mesenteric vein. A recanalized portal vein allows a conventional end-to-end portal venous anastomosis without adding to the complexity of orthotopic liver transplantation (OLT).…”

Section: Correct Answers: C and Ementioning

confidence: 99%