Portal vein thrombosis in patients with cirrhosis

Köckritz, Leona Isabella von; Gottardi, Andrea De; Trebicka, Jonel; Praktiknjo, Michael

doi:10.1093/gastro/gox014

Cited by 32 publications

(30 citation statements)

References 73 publications

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“…More than two-thirds of cirrhosis patients with PVT have some evidence of inherited thrombophilia [14]. Prothrombin (PT) gene 20210A mutation is associated with a more than five-fold increased risk of developing PVT [15].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background Portal vein thrombosis (PVT) is a complication that is commonly seen in patients with cirrhosis and an entity that leads to increased mortality in patients who undergo liver transplantation. This study aims to establish a link between an elevated international normalized ratio (INR) and the presence of PVT in a cohort of cirrhotic patients. Methods We retrospectively reviewed the electronic medical records of all patients diagnosed with cirrhosis in SBH Health System from 2013 to 2018. Among these patients we extracted baseline demographic data, laboratory results, co-morbidities and the presence of PVT. Results In total there were 268 patients who met our inclusion criteria. Twenty-two patients had PVT, while 246 patients did not. Of the 22 patients with PVT there was a statistically significant increase in INR when compared to patients without PVT. There was also a statistically significant increase in total bilirubin, alkaline phosphatase and platelet count. Conclusions Elevated INR levels are associated with the presence of PVT in patients with cirrhosis. These findings suggest a hypercoagulable state and could assist clinicians in risk-stratifying patients when making the decision to initiate anti-coagulation therapy.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Although this meta-analysis excluded neoplasms and inflammatory conditions to avoid heterogeneity and selection bias, previous research studies have also found these conditions to be independent risk factors for patients with cirrhosis without inherited thrombophilias to develop PVT. 27 Whether patients with tumoral PVT have an increased rate of inherited thrombophilias remains unclear and is an interesting avenue for future study. In general, data on inherited thrombophilia and risk of PVT in malignancy are limited;…”

Section: Ta B L E 2 (Continued)mentioning

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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“… 87 PVT prophylaxis may be indicated in cirrhotic patients awaiting LT or after hepatic resection. 117 …”

Section: Perioperative Antithrombotic Managementmentioning

confidence: 99%

Hypercoagulability in End-stage Liver Disease: Review of Epidemiology, Etiology, and Management

Verbeek

Stine

Saner

et al. 2018

Transplantation Direct

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In this review, we analyze the epidemiology of thromboses related to end-stage liver disease (ESLD), discuss causes of hypercoagulability, describe susceptible populations, and critically evaluate proposed prophylaxis and treatment of thromboses. Classically, ESLD has been regarded as a model for coagulopathy, and patients were deemed to be at high risk for bleeding complications. Patients with ESLD are not auto-anticoagulated, and they do not have a lower risk of portal vein thrombosis, intracardiac thrombus formation, pulmonary embolism or hepatic artery thrombosis. Though the cause of hypercoagulability is multifactorial, endothelial dysfunction likely plays a central role for all patients with ESLD. Some subpopulations, such as patients with nonalcoholic steatohepatitis and autoimmune conditions, are at increased risk of thrombotic events as are patients of Hispanic ethnicity. The science behind prophylaxis of different types of clotting and treatment of thromboses is developing rapidly. A number of medications, including low molecular weight heparin, unfractionated heparin, aspirin, vitamin K antagonists, and direct oral anticoagulants can be used, but clear guidelines are lacking. Acute intraoperative clotting can be associated with high mortality. Routine use of transesophageal echocardiography can be helpful in early recognition and treatment of intraoperative thrombosis. Heparin should be reserved for cases of intracardiac thrombus/pulmonary embolism without hemodynamic instability. In unstable patients, low dose of recombinant tissue plasminogen activator can be used. In this new era of heightened awareness of thrombotic events in ESLD patients, prospective randomized trials are urgently needed to best guide clinical practice.

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Portal vein thrombosis in patients with cirrhosis

Cited by 32 publications

References 73 publications

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

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

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

Hypercoagulability in End-stage Liver Disease: Review of Epidemiology, Etiology, and Management

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