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Inicio Gastroenterología y Hepatología (English Edition) Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis i...
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Vol. 41. Issue 10.
Pages 611-617 (December 2018)
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Vol. 41. Issue 10.
Pages 611-617 (December 2018)
Original article
DOI: 10.1016/j.gastre.2018.11.023
Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis
Eficacia y seguridad de la anticoagulación en la trombosis de la vena porta benigna en pacientes con cirrosis hepática
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Tomas Artaza
Corresponding author
tdeartaza@gmail.com

Corresponding author at: Department of Gastroenterology, Hospital Virgen de la Salud, Avenida Barber, 30, 45004, Toledo, Spain.
, Miriam Lopes, Marta Romero, Ana-Zaida Gómez, Gema de la Cruz, Juan José Sánchez, Concepción González, Rafael Gómez
Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain
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Tables (3)
Table 1. Main baseline characteristics of 32 patients with portal vein thrombosis.
Table 2. Predictors of portal vein thrombosis response to anticoagulation therapy.
Table 3. Characteristics of patients with bleeding complications (at time zero).
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Abstract
Background and aim

Treatment for portal vein thrombosis (PVT) is not well established. Nevertheless, anticoagulation therapy can seemingly be used as first-line therapy. However, there are limited data on the role of this treatment in patients with PVT and cirrhosis. We sought to assess the safety and efficacy of anticoagulation therapy in a series of patients with non-malignant PVT and liver cirrhosis.

Methods

We analyzed the data of 32 patients with cirrhosis and PVT between March 2009 and September 2015. All patients received anticoagulation treatment. PVT was diagnosed within the context of biannual hepatocellular carcinoma screening in these patients.

Results

Recanalisation was achieved in 23 patients: complete in 17 patients (53.1%) and partial in 6 patients (18.7%). The median time for achieving a complete response was 7 months (95% CI: 6–8). We did not discover any risk factors associated with repermeation (partial or complete). None of the patients presented with thrombosis progression while receiving anticoagulation. Nine patients who achieved complete recanalisation and stopped anticoagulation therapy suffered rethrombosis (52%). There were no differences between the patients who achieved complete or partial recanalisation (35%) and those who did not (33%) in relation to the onset of hepatic events during follow-up. Three patients (9%) presented with bleeding complications: two variceal bleeding episodes and one brain hemorrhage.

Conclusions

In cirrhotic patients with non-malignant PVT, anticoagulation therapy led to partial or complete recanalisation in 70% of patients, with a broad safety profile. Due to the existing rethrombosis rate, long-term anticoagulation should be considered.

Keywords:
Portal vein thrombosis
Liver cirrhosis
Anticoagulation
Abbreviations:
PVT
CT
MRI
Resumen
Antecedentes y objetivo

El tratamiento de la trombosis de la vena porta (TVP) no está bien consolidado. Sin embargo, parece que el tratamiento anticoagulante puede ser el tratamiento inicial. Con todo, hay datos limitados sobre el papel de este tratamiento en pacientes con TVP y cirrosis. Intentamos evaluar la seguridad y eficacia del tratamiento anticoagulante en una serie de pacientes con TVP benigna y cirrosis hepática.

Métodos

Analizamos datos de 32 pacientes con cirrosis y TVP entre marzo de 2009 y septiembre de 2015. Todos los pacientes recibieron tratamiento anticoagulante. La TVP se diagnosticó en el contexto de la detección bianual de carcinoma hepatocelular en estos pacientes.

Resultados

La recanalización se logró en 23 pacientes: completa en 17 pacientes (53,1%) y parcial en 6 pacientes (18,7%). La mediana de tiempo para conseguir esta respuesta completa fue 7 meses (IC95: 6–8). No descubrimos ningún factor asociado con la posibilidad de reinfiltración (parcial o completa). Ninguno de los pacientes presentó progresión de la trombosis durante la anticoagulación. Nueve pacientes que lograron una recanalización completa y suspendieron el tratamiento anticoagulante presentaron retrombosis (52%). No hubo diferencias entre los pacientes que lograron la recanalización completa o parcial (35%) y los que no lograron la recanalización (33%) en relación con el desarrollo de sucesos hepáticos durante el seguimiento. Tres pacientes (9%) presentaron complicaciones hemorrágicas: dos episodios de sangrado varicoso y una hemorragia cerebral.

Conclusiones

En pacientes cirróticos con TVP benigna, el tratamiento anticoagulante produjo la recanalización parcial o completa en el 70% de los pacientes, con un amplio perfil de seguridad. Debido a la tasa de retrombosis existente, se debe considerar la anticoagulación a largo plazo.

Palabras clave:
Trombosis de la vena porta
Cirrosis hepática
Anticoagulación

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