Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study

Gao, Zhanjuan; Zhao, Junli; Liu, Xiaofeng; Li, Senlin; Wang, Minghui; Gao, Yanjing

doi:10.1007/s12072-021-10224-4

Cited by 17 publications

(15 citation statements)

References 47 publications

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“…[16] The previous study has reported that 14-day and 6-week rebleeding rates are higher in patients with PVT than those without PVT after esophageal variceal band ligation (EVL), [17] and 17.3% of patients with acute variceal bleeding suffer from PVT. [18] In the case of PVT, the blood owing into the liver reduces, which induces intestinal edema, bacterial translocation, and liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…High albumin levels possibly served as a protective factor for the 14-day and 6-week rebleeding risk in patients after EVL. [17] Theoretically, abundant albumin infusion in patients with GIB may cause rebleeding due to increased portal pressure in a manner similar to the liberal transfusion strategy. [27] The necessity of albumin infusion in patients without hypoproteinemia and the related dosage remains to be clari ed.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic capability of portal vein thrombosis for rebleeding in cirrhotic patients after esophagogastric devascularization and splenectomy

Han

Shu

Yue

et al. 2022

Preprint

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Background Esophagogastric devascularization and splenectomy (EGDS) is widely used to treat patients with portal hypertension in China. This study aimed to determine the risk factors of rebleeding after EGDS and evaluate the effect of portal vein thrombosis (PVT) on rebleeding during the postoperative period after EGDS. Methods Cirrhotic patients with portal hypertension who had undergone EGDS were included. The patients were assigned to either the rebleeding or the non-rebleeding group with follow-up time. Results A total of 138 consecutive patients who underwent EGDS and met the criteria were included in this study. The 3-year and 5-year rebleeding rates of all patients were 18.12% (25/138) and 27.54% (38/138), respectively. The total bilirubin (TBIL) (HR: 2.392, 95% CI 1.032–5.545, p = 0.042) and PVT (HR: 3.345, 95% CI 1.477–7.573, p = 0.004) were identified as the predictors of 3-year rebleeding in univariate analysis. Multivariate analysis revealed that the PVT (HR: 3.967, 95% CI 1.742–9.035, p = 0.001) was an independent factor. Hemoglobin > 87.5 g/L (HR: 3.104, 95% CI 1.283–7.510, p = 0.012) and PVT (HR: 2.349, 95% CI 1.231–4.483, p = 0.010) were the predictors of 5-year rebleeding in multivariate analysis. Albumin > 37.5 g/L was the only independent predictor of 3-year and 5-year rebleeding in patients with PVT. Conclusions The PVT is associated with 3-year and 5-year rebleeding in patients after EGDS but not 10-year rebleeding. Hemoglobin > 87.5 g/L is another predictor of 5-year rebleeding. High albumin levels may serve as a predictor of 3-year and 5-year rebleeding risk in patients with PVT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic capability of portal vein thrombosis for rebleeding in cirrhotic patients after esophagogastric devascularization and splenectomy

Han

Shu

Yue

et al. 2022

Preprint

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“…28 In our trial, we did not exclude patients with Child-Pugh grade C. Consequently, considering clinical safety, we did not plan to use NSBBs as the essential treatment for patients with Child-Pugh grade C included in this trial. Furthermore, NSBBs have been reported to increase the risk of portal vein thrombosis in patients with cirrhosis with esophagogastric varices [29][30][31] ; at the same time, out-of-hospital application of NSBBs poses a great risk for patients with poor compliance; thus, we do not choose to routinely apply NSBBs. However, if the patients need a combination of NSBBs for secondary prophylaxis, we will administer NSBBs to them.…”

Section: Discussionmentioning

confidence: 99%

Timing of endoscopic intervention in patients with cirrhosis with acute variceal haemorrhage (TEACH trial): protocol for a randomised clinical trial (RCT)

et al. 2022

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IntroductionAcute variceal haemorrhage (AVH) in patients with cirrhosis remains a topic of great interest. Although several guidelines recommend endoscopy within 24 hours after AVH, there is no consensus on the most appropriate time to perform this intervention. The purpose of this study is to identify whether urgent endoscopy (within 6 hours after gastroenterological consultation) is superior to non-urgent endoscopy (between 6 hours and 24 hours after gastroenterological consultation) in reducing the rebleeding rate of these patients.Methods and analysisThis is a single-centred, prospective, randomised clinical trial. Between March 2021 and December 2023, an estimated 400 patients will be randomised in a 1:1 ratio to receive endoscopic intervention either within 6 hours or between 6 and 24 hours after gastroenterological consultation. Randomisation will be conducted by permuted block randomisation, with stratification by age, systolic blood pressure and pulse rate. The primary efficacy endpoint is rebleeding within 42 days after control of AVH. The secondary efficacy endpoints mainly include all-cause mortality within 42 days after randomisation, persistent bleeding, length of hospitalisation, etc.Ethics and disseminationThe study protocol was approved by the Ethical Committees of Jinling Hospital (authorised ethics no. DZQH-KYLL-21-01). This trial will provide valuable insights into the timing of endoscopic intervention for AVH in patients with cirrhosis. Furthermore, the trial results and conclusions could provide high-quality evidence to guide clinical research and treatment.Trial registration numberNCT04786743.

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“…AVB is a severe complication of liver cirrhosis, with a high rate of recurrence and death. For AVB, most adverse events (i.e., death, failure to control bleeding, and rebleeding ) occur within the rst ve days and are de ned as the 5-day failure [4]. So, it is still challenging for clinicians to initiate anticoagulation in PVT patients having cirrhosis and AVB.…”

Section: Impact On Liver Functionmentioning

confidence: 99%

“…A systematic review observed a higher rate of 5-day failure, 14-day, 6-week, and 1-year rebleeding in cirrhotic AVB patients combined with PVT [3]. Our team recently veri ed that PVT was associated with high 14-day and 6-week rebleeding among AVB patients after esophageal variceal band ligation (EVL) [4].…”

Section: Introductionmentioning

confidence: 99%

Initiation of anticoagulation therapy within 48-hour after esophageal variceal band ligation is safe in portal vein thrombosis patients having cirrhosis and acute variceal bleeding: A multi-centric randomized controlled trial

Gao

Zhao

et al. 2022

Preprint

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Background and aims: Portal vein thrombosis (PVT) and acute variceal bleeding (AVB) are recurrent complications of cirrhosis. Safety, efficacy, and initiation time of anticoagulant treatment among cirrhotic patients having PVT and AVB are controversial issues. We aimed to establish the safety and efficacy of nadroparin calcium warfarin sequential (NWS) anticoagulation therapy within 48-hour after esophageal variceal band ligation within PVT patients having cirrhosis and AVB.Methods: Cirrhotic patients having AVB and PVT who underwent EVL were included and randomly allocated to either the NWS therapy group (one-month nadroparin calcium by subcutaneous injection following five-month warfarin through oral administration) or the control group (without any anticoagulation therapy). Five-day failure, 14-day, four-weeks, and six-month rebleeding rates after EVL, other major bleeding events in specific sites, and recanalization rate of PVT among the two groups were assessed at six months. Results: 118 patients were eligible and randomly divided into the NWS group and the control group, with 59 patients in either group. No patients experienced five-day failure in both groups. There was no significant difference in the rate of 14-day (0 vs. 1.7%, P = 1.000), four-week (0 vs. 3.4%, P = 0.476), and six-month rebleeding (11.9% vs. 18.6%, P = 0.36) between the two groups. The overall recanalization (complete and partial) rate in the NWS therapy group was significantly higher than in the control group (67.8% vs. 40.7%, P = 0.003). Low Child-Pugh score (P = 0.005), D-dimer<2.00 ug/mL (P = 0.016), and NWS anticoagulation therapy (P = 0.004) were the predictors of PVT recanalization through univariate analysis of binary logistic regression. NWS anticoagulation therapy (P = 0.004) was the independent factor of recanalization through multivariate analysis. In the NWS group, the Child-Pugh score (6.77 ±1.36 vs. 6.00 ±1.00, P = 0.001) and the albumin level (35.01 ±5.95 vs. 36.95 ±4.27, P = 0.048) were significantly improved at the sixth month.Conclusions: Initiation of NWS anticoagulation therapy within 48-hour after EVL is safe with better efficacy against PVT patients having cirrhosis and AVB. Moreover, it can also improve liver function.

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Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study

Cited by 17 publications

References 47 publications

Prognostic capability of portal vein thrombosis for rebleeding in cirrhotic patients after esophagogastric devascularization and splenectomy

Prognostic capability of portal vein thrombosis for rebleeding in cirrhotic patients after esophagogastric devascularization and splenectomy

Timing of endoscopic intervention in patients with cirrhosis with acute variceal haemorrhage (TEACH trial): protocol for a randomised clinical trial (RCT)

Initiation of anticoagulation therapy within 48-hour after esophageal variceal band ligation is safe in portal vein thrombosis patients having cirrhosis and acute variceal bleeding: A multi-centric randomized controlled trial

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