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Florescu MM, Costache A, Iacob SM, Pietrareanu C, Ester C, Cerban R, Dumitru R, Grasu M, Lupescu I, Gheorghe L. Anticoagulation Therapy for Portal Vein Thrombosis in Patients with Cirrhosis in a Tertiary Center Experience. J Gastrointestin Liver Dis 2021; 30:374-379. [PMID: 34551038 DOI: 10.15403/jgld-3392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The evidence regarding the use of anticoagulant (AC) agents in portal vein thrombosis (PVT) is increasing and, most patients undergo chronic treatment with low molecular weight heparin (LMWH) or vitamin K antagonists (VKA). Nevertheless, there are no clear data about who should receive antithrombotic therapy, when to initiate it, how long and what dose should be used for this set of patients. The aim of the study was to assess the outcome of patients with cirrhosis and portal vein thrombosis who received AC therapy, in terms of thrombus regression, bleeding events and survival rates. METHODS This observational and retrospective study included 107 cirrhotic patients diagnosed with PVT in a single tertiary center between 2010-2019. 54 received low molecular weight heparin or vitamin K antagonist (AC treatment group) and 53 were untreated. All patients were periodically follow-up to assess the evolution of PVT (regression, progression, stable thrombus) and potential occurrence of bleeding events. RESULTS The regression of portal vein thrombosis was significantly higher in the AC treatment group (OR=2.430; 95% CI=1.11-6.167; p=0.026), more than 50% of on-treatment patients experiencing regression of the thrombus. However, bleeding events were significantly more frequent in the AC treatment group (18.5% vs. 7.5%) and the risk of bleeding was associated with thrombocytes less than 50x103/mm3 (OR=8.266; 95%CI: 2.310-39.211; p=0.002). Survival was better in the AC treatment group (68.4% vs 48.7% at 5 years and 92.7% vs 77.8% at 1 year, p=0.038) and was lower in patients that experienced bleeding events (37.22% survival at 5 years, mean time survival 44 months, p=0.008). CONCLUSIONS In our cohort of cirrhotic patients with PVT more than 50% of patients receiving AC therapy presented regression of the thrombus; most of them obtained partial recanalization. The bleeding complication rate was higher than expected, reaching 18%. The overall mortality was lower in the treated group.
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Affiliation(s)
| | - Adrian Costache
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Dr. Ioan Cantacuzino Clinical Hospital, Bucharest; 4) Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Speranta Maria Iacob
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Corina Pietrareanu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Carmen Ester
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Razvan Cerban
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Radu Dumitru
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Mugur Grasu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Ioana Lupescu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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