Portal Vein Thrombosis in Patients With Cirrhosis Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors, Warfarin Efficacy, and Clinical Outcomes

Abstract

Portal vein thrombosis (PVT) is a common complication in cirrhosis. The aim of this study was to determine risk factors for PVT, assess the efficacy of anticoagulant therapy, and evaluate the effects of PVT on patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt (TIPSS). A total of 101 patients with cirrhosis undergoing elective TIPSS were prospectively studied. After TIPSS, all patients received preventive therapy for PVT and were followed up at 3, 6, 12, and 24 months. Clinical outcomes were compared between patients who developed PVT after TIPSS and those who did not. Multivariate analysis showed that white blood cell count (relative risk [RR]: 0.377; 95% confidence interval [CI]: 0.132-0.579; P = .001), Child-Turcotte-Pugh score (RR: 1.547; 95% CI: 1.029-2.365; P = .032), and ascites (RR: 1.264; 95% CI: 1.019-1.742; P = .040) were independent predictors for PVT. Warfarin treatment within 12 months achieved significantly higher rates of complete recanalization than aspirin or clopidogrel in patients with PVT (54.5% vs 31.3%; P = .013), although adverse events were similar between the 2 groups ( P > .05). Patients without PVT had significantly lower 2-year cumulative rates of variceal rebleeding (15.9% vs 36.6%; P = .023), shunt dysfunction (27.0% vs 46.8%; P = .039), hepatic encephalopathy (24.1% vs 42.6%; P = .045), and hepatocellular carcinoma (11.4% vs 31.2%; P = .024) and markedly higher 2-year cumulative survival rates (89.8% vs 72.9%; P = .041) than those with PVT. The PVT is associated with poorer clinical outcomes in TIPSS-treated patients, and warfarin is both safe and more effective in recanalizing PVT than aspirin or clopidogrel.

Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis

“…63 In contrast, Wan et al reported that warfarin could effectively promote recanalization in approximately 50% of patients within 1 year in those with de novo post-TIPS PVT. 64 The incidence of PVT in the warfarin group (15%) was 3-fold lower than that in the control group (43%). 64…”

“…64 The incidence of PVT in the warfarin group (15%) was 3-fold lower than that in the control group (43%). 64…”

Risk Factors Regarding Portal Vein Thrombosis in Chronic Liver Disease

“…The leukocytosis in our study could be the result of the endotoxin that reaches the portal system and is capable to activate coagulation process and lead to thrombus. (7) Endotoxemia has long been discovered in patients with hepatic disorders at higher levels than in healthy individuals which increase progressively with the hepatic disease, depending on the Child-Pugh stage. (8) Acute infections are associated with an increased transient risk in the development of venous thromboembolic events.…”

Efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of schistosomiasis-induced portal hypertension: a retrospective case series

“…TIPS was successfully placed in all patients (technical success rate 100%). The median follow-up time was 16 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. The mean age of the patients was 58 years (95% CI, 54.1-61.9 years), of which 31 (73.0%) were males.…”