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Rao R, Grosel J. Acute portal vein thrombosis in a 59-year-old male with JAK2 V617F mutation. Radiol Case Rep 2018; 13:1249-1255. [PMID: 30258517 PMCID: PMC6148830 DOI: 10.1016/j.radcr.2018.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/23/2018] [Accepted: 08/26/2018] [Indexed: 12/24/2022] Open
Abstract
Portal vein thrombosis is an uncommon finding that typically arises in the context of cirrhosis. In the acute setting, it may present with abdominal pain, portal hypertension, ascites, gastrointestinal bleeding, or mesenteric ischemia. Local risk factors that predispose its formation include: cirrhosis, hepatocellular carcinoma, pancreatitis, and intraabdominal infection. Systemic factors, including hypercoagulable states and sepsis, also pose an increased risk. JAK2 V617F positive myeloproliferative disorders are associated with systemic prothrombotic states and are a less frequently identified cause of portal vein thrombosis. We present a case of acute unprovoked portal vein thrombosis diagnosed in a 59-year-old male without local disease factors. Computed tomography, magnetic resonance cholangiopancreatography, and ultrasound demonstrated the presence of portal vein thrombosis with neighboring periportal and pancreatic head edema. Peripheral blood testing detected the presence of JAK2 V617F mutation. The patient was discharged on 6-month anticoagulation therapy and outpatient follow-up.
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Affiliation(s)
- Rahul Rao
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - John Grosel
- Riverside Radiology and Interventional Associates, Inc., Associate Professor Marietta College PA Program, 401 Matthew St. Marietta, OH 45750, United States
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Wei Y, Chen X, Shen H, Wu W, Cao G, Chen W, Wang Y, Shen H, Yu S, Zhang J. P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis. Clin Appl Thromb Hemost 2018; 24:76S-83S. [PMID: 30033741 PMCID: PMC6714827 DOI: 10.1177/1076029618788180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We aimed to investigate the changes in p-selectin (p-sel), thrombus precursor protein, and D-dimer (D-D) in patients with cirrhosis after portal hypertensive splenectomy and explore its values on the prediction of postoperative portal vein thrombosis (PVT) formation. A total of 144 patients with cirrhosis with portal hypertension who underwent portal hypertensive splenectomy from January 2009 to December 2016 were enrolled in this study and divided into the thrombus and nonthrombus groups. The levels of p-sel, thrombus precursor protein (TpP), and D-D were measured by flow cytometry, enzyme-linked immunosorbent assay, and immunoturbidimetry, respectively. Sensitivity, specificity, and other values for p-sel, TpP, and D-D were calculated. The linear discriminant, logistic regression, and decision tree methods were used to analyze the p-sel value on the prediction of PVT formation. Seventy-nine patients were confirmed having postoperative PVT, with the incidence rate of 54.86%. No significant differences were observed in the p-sel, TpP, and D-D between the thrombus and nonthrombus groups before surgery, but these 3 indexes were obviously elevated in the thrombus group after operation (P < .01). P-selectin level on first day showed the highest positive predictive value (91.0%) and diagnostic coincidence rate (83.3%), while negative expected value (76.6%) was lower than those of TpP and D-D. Multiple analyses showed the prediction accuracy of PVT was 61.1% (P = .023), 97.2% (P < .001), and 97.2% (P < .001), respectively. P-selectin has a significant value in predicting PVT. P-selectin level on first and third day is valuable and feasible for the early prediction of PVT.
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Affiliation(s)
- Yunhai Wei
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Xuedong Chen
- School of Science, Huzhou University, Huzhou, People's Republic of China
| | - Huaping Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wanbo Wu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Guoliang Cao
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wenxian Chen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Yan Wang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Hua Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Sheng Yu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Jinyu Zhang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
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Fei Y, Zong GQ, Chen J, Liu RM. Evaluation the value of markers for prediction of portal vein thrombosis after devascularization. Ann Hepatol 2016; 14:856-61. [PMID: 26436357 DOI: 10.5604/16652681.1171772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To evaluate the value of D-dimer and P-selectin in cirrhotic portal hypertension (PHT) patients for prediction of portal vein thrombosis (PVT) after devascularization. MATERIAL AND METHODS 137 patients with cirrhotic PHT who undergone devascularization from January 2012 to April 2014 were retrospectively reviewed, all of them were divided into two groups (PVT group and non-PVT group) by Doppler ultrasonography (DU) examination. The level of D-dimer and P-selectin was tested during the peri-operative period. RESULTS 38 patients (27.7%) were found PVT by DU examination post-operatively. In contrast to the non- PVT group, the level of D-dimer and P-selectin in the PVT group was much higher significantly at 1, 3 and 7 days after devascularization (P < 0.05). However, in the 15 days after surgery, the difference of P-selectin between the two groups was not significant (P = 0.260). It was shown that the higher sensitivity of the two markers for PVT was D-dimer, the higher specificity belonged to P-selectin. The area under receiver operating characteristic (ROC) curve of P-selectin was the bigger of the two markers. When the two markers were combined to be used to diagnose PVT, the sensitivity was increased to 0.911, with a slight drop of specificity to 0.715, the area under ROC curve was 0.919. CONCLUSION The level of D-dimer and P-selectin might be good candidate predictive markers for PVT in patients with cirrhotic PHT after devascularization. The combined test of the two markers can increase the value of prediction.
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Affiliation(s)
- Yang Fei
- Department of General Surgery, the 81st Hospital of P.L.A. Nanjing, JiangSu, China
| | - Guang-quan Zong
- Department of General Surgery, the 81st Hospital of P.L.A. Nanjing, JiangSu, China
| | - Jian Chen
- Department of General Surgery, the 81st Hospital of P.L.A. Nanjing, JiangSu, China
| | - Ren-min Liu
- Department of General Surgery, the 81st Hospital of P.L.A. Nanjing, JiangSu, China
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Zhou J, Yang JH. Progress in treatment of nontumoral portal vein thrombosis in liver cirrhosis. Shijie Huaren Xiaohua Zazhi 2015; 23:735-740. [DOI: 10.11569/wcjd.v23.i5.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is not uncommon in patients with liver cirrhosis, and it increases the risk of gastroesophageal hemorrhage. At present, pharmacological treatment is the preferred selection of management of PVT. Studies have shown that anticoagulation therapy does not increase the risk of gastrointestinal bleeding. Therefore, patients having indications should be given anticoagulation therapy as early as possible. When patients fail to respond to anticoagulation therapy, interventional therapy or surgery may be considered. This article reviews the recent knowledge about the treatment of PVT and discusses the progress in treatment of nontumoral PVT in liver cirrhosis.
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Fei Y, Zong GQ, Chen J, Liu RM. Evaluation of the Value of d-Dimer, P-Selectin, and Platelet Count for Prediction of Portal Vein Thrombosis After Devascularization. Clin Appl Thromb Hemost 2015; 22:471-5. [PMID: 25633343 DOI: 10.1177/1076029615569273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background/Aim: To evaluate the value of d-dimer, P-selectin, and platelet count in patients with cirrhotic portal hypertension (PHT) for prediction of portal vein thrombosis (PVT) after devascularization. Methods: A total of 137 patients with cirrhotic PHT who undergone devascularization from January 2012 to April 2014 were retrospectively reviewed, all of them were divided into 2 groups (PVT group and non-PVT group) by Doppler ultrasonography (DU) examination. The level of d-dimer, P-selectin, and platelet count was tested during the perioperative period. Results: In all, 38 (27.7%) patients were found to have PVT by DU examination postoperatively. In contrast to the non-PVT group, the level of d-dimer, P-selectin, and platelet count in the PVT group was much higher significantly at 1, 3, and 7 days after devascularization. ( P < .05). However, in the 15 days after surgery, the difference in P-selectin between the 2 groups was not significant ( P = .260). It was shown that the highest sensitivity of the 3 markers for PVT was d-dimer, the highest specificity belonged to P-selectin. The area under receiver–operating characteristic (ROC) curve of P-selectin was the biggest of the 3 markers. When the 3 markers were combined to be used to diagnose PVT, the sensitivity was increased to 0.907, with a slight drop of specificity to 0.693, the area under the ROC curve was 0.927. Conclusion: The level of d-dimer, P-selectin, and platelet count might be good candidate predictive markers for PVT in patients with cirrhotic PHT after devascularization. The combined test of the 3 markers can increase the value of prediction.
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Affiliation(s)
- Yang Fei
- Department of General Surgery, the 81st Hospital of P.L.A., P.L.A. Cancer Center, Nanjing, China
| | - Guang-quan Zong
- Department of General Surgery, the 81st Hospital of P.L.A., P.L.A. Cancer Center, Nanjing, China
| | - Jian Chen
- Department of General Surgery, the 81st Hospital of P.L.A., P.L.A. Cancer Center, Nanjing, China
| | - Ren-min Liu
- Department of General Surgery, the 81st Hospital of P.L.A., P.L.A. Cancer Center, Nanjing, China
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