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Raja K, Jacob M, Asthana S. Portal vein thrombosis in cirrhosis. J Clin Exp Hepatol. 2013;4(4):320-31doi: 10.1016/j.jceh.2013.12.003.
Raja, K., Jacob, M., & Asthana, S. (2014). Portal vein thrombosis in cirrhosis. Journal of clinical and experimental hepatology, 4(4), 320-31. https://doi.org/10.1016/j.jceh.2013.12.003
Raja, Kaiser, et al. "Portal vein thrombosis in cirrhosis." Journal of clinical and experimental hepatology vol. 4,4 (2014): 320-31. doi: https://doi.org/10.1016/j.jceh.2013.12.003
Raja K, Jacob M, Asthana S. Portal vein thrombosis in cirrhosis. J Clin Exp Hepatol. 2014 Dec;4(4):320-31. doi: 10.1016/j.jceh.2013.12.003. Epub 2013 Dec 31. PMID: 25755579; PMCID: PMC4298635.
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J Clin Exp Hepatol. 2014 Dec;4(4):320-31. doi: 10.1016/j.jceh.2013.12.003. Epub 2013 Dec 31.

Portal vein thrombosis in cirrhosis.

Journal of clinical and experimental hepatology

Kaiser Raja, Mathew Jacob, Sonal Asthana

Affiliations

  1. Department of Hepatology, Hepatobiliary Surgery & Multiorgan Transplantation, Global Integrated Liver Care Program, BGS Global Hospitals, Bangalore, India.

PMID: 25755579 PMCID: PMC4298635 DOI: 10.1016/j.jceh.2013.12.003

Abstract

Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term.

Keywords: DVT, deep vein thrombosis; EVL, endoscopic variceal ligation; INR, international normalized ratio; IVC, inferior vena cava; LMWH, low molecular weight heparin; MELD, model for end stage liver disease; MTHFR, methylene-tetrahydrofolate reductase; PE, pulmonary embolism; PT, prothrombin time; PVT, portal vein thrombosis; SMV, superior mesenteric vein; TEG, thromboelastography; TIPS, transjugular intrahepatic portosystemic shunt; US, ultrasonography; VKA, vitamin K antagonists; anticoagulation; cirrhosis; portal vein thrombosis; portocaval hemitransposition

References

  1. J Surg Res. 1996 Feb 1;60(2):333-8 - PubMed
  2. World J Gastroenterol. 2010 Jan 14;16(2):143-55 - PubMed
  3. J Clin Gastroenterol. 2010 Jul;44(6):448-51 - PubMed
  4. Hepatology. 2003 Sep;38(3):599-612 - PubMed
  5. Clin Liver Dis. 2009 Feb;13(1):1-9 - PubMed
  6. Blood Rev. 2003 Sep;17(3):179-85 - PubMed
  7. Am J Gastroenterol. 2006 Jul;101(7):1524-8; quiz 1680 - PubMed
  8. Clin Transplant. 2006 Sep-Oct;20(5):551-62 - PubMed
  9. Gastroenterology. 2009 Dec;137(6):2105-11 - PubMed
  10. Clin Transplant. 2010 Jan-Feb;24(1):48-55 - PubMed
  11. Clin Liver Dis. 2009 Feb;13(1):67-71 - PubMed
  12. Hepatology. 2007 Sep;46(3):922-38 - PubMed
  13. N Engl J Med. 2011 Jul 14;365(2):147-56 - PubMed
  14. J Thromb Haemost. 2011 Sep;9(9):1713-23 - PubMed
  15. Clin Liver Dis. 2009 Feb;13(1):55-61 - PubMed
  16. Hepatology. 2009 May;49(5):1729-64 - PubMed
  17. Eur J Gastroenterol Hepatol. 2010 Sep;22(9):1093-8 - PubMed
  18. Blood. 2002 Jul 15;100(2):539-46 - PubMed
  19. Endoscopy. 1996 Jun;28(5):461 - PubMed
  20. J Hepatol. 1995 Feb;22(2):165-72 - PubMed
  21. Endoscopy. 2002 Jul;34(7):535-8 - PubMed
  22. Liver Int. 2012 Jul;32(6):919-27 - PubMed
  23. J Hepatol. 2013 Aug;59(2):358-66 - PubMed
  24. Aliment Pharmacol Ther. 2010 Feb 1;31(3):366-74 - PubMed
  25. Eur J Radiol. 2010 Aug;75(2):185-8 - PubMed
  26. HPB (Oxford). 2007;9(5):352-6 - PubMed
  27. Transplantation. 1994 Apr 15;57(7):1046-51 - PubMed
  28. J Lab Clin Med. 2005 Oct;146(4):238-43 - PubMed
  29. J Hepatol. 2004 May;40(5):736-41 - PubMed
  30. Hepatology. 1982 Sep-Oct;2(5):637-40 - PubMed
  31. Int J Hepatol. 2012;2012:672986 - PubMed
  32. Transplantation. 2012 Dec 15;94(11):1145-53 - PubMed
  33. Gastroenterology. 1985 Aug;89(2):279-86 - PubMed
  34. Thromb Haemost. 1997 Jan;77(1):44-7 - PubMed
  35. J Clin Gastroenterol. 2007 Nov-Dec;41 Suppl 3:S259-61 - PubMed
  36. Transplant Proc. 2002 Dec;34(8):3331-3 - PubMed
  37. Hepatology. 2000 Feb;31(2):345-8 - PubMed
  38. J Hepatol. 2011 Jan;54(1):78-88 - PubMed
  39. Aliment Pharmacol Ther. 2006 Mar 15;23 (6):767-75 - PubMed
  40. Surg Gynecol Obstet. 1985 Jul;161(1):66-8 - PubMed
  41. Transplant Proc. 2005 Mar;37(2):1119-21 - PubMed
  42. Gastroenterology. 1991 Jan;100(1):160-7 - PubMed
  43. Eur J Gastroenterol Hepatol. 2005 Jul;17(7):745-51 - PubMed
  44. Hepatology. 2006 Jul;44(1):53-61 - PubMed
  45. Haemostasis. 1993 Jul-Aug;23(4):229-35 - PubMed
  46. Dig Liver Dis. 2010 Jun;42(6):451-5 - PubMed
  47. Pathophysiol Haemost Thromb. 2003;33(1):4-15 - PubMed
  48. J Hepatol. 2009 Oct;51(4):682-9 - PubMed
  49. Liver Int. 2011 Jan;31(1):75-82 - PubMed
  50. Hepatology. 1998 Jan;27(1):15-9 - PubMed
  51. Liver Transpl. 2010 Jan;16(1):83-90 - PubMed
  52. Haematologica. 2003 May;88(5):547-54 - PubMed
  53. Hepatology. 2006 Aug;44(2):440-5 - PubMed
  54. J Hepatol. 2009 May;50(5):916-22 - PubMed
  55. Gastroenterology. 1995 Aug;109(2):531-9 - PubMed
  56. Transplantation. 2000 May 15;69(9):1873-81 - PubMed
  57. Hepatology. 2008 Apr;47(4):1384-93 - PubMed
  58. Hepatology. 1988 Mar-Apr;8(2):232-6 - PubMed
  59. Liver Transpl. 2010 May;16(5):658-67 - PubMed
  60. AJR Am J Roentgenol. 1990 Dec;155(6):1237-40 - PubMed
  61. Liver Transpl. 2010 Aug;16(8):999-1005 - PubMed
  62. J Hepatol. 2011 Oct;55(4):945-6; author reply 947-8 - PubMed
  63. Rev Esp Enferm Dig. 2008 May;100(5):259-62 - PubMed
  64. Dig Dis Sci. 1996 Jan;41(1):185-90 - PubMed
  65. Radiology. 2004 Apr;231(1):231-6 - PubMed
  66. Ann Surg. 2011 Feb;253(2):378-84 - PubMed
  67. Liver Transpl. 2001 Feb;7(2):125-31 - PubMed
  68. AJR Am J Roentgenol. 1997 Mar;168(3):719-23 - PubMed
  69. J Vasc Interv Radiol. 2005 May;16(5):651-61 - PubMed
  70. Am J Gastroenterol. 2013 Apr;108(4):568-74 - PubMed
  71. Transplant Proc. 2005 Mar;37(2):1112-4 - PubMed
  72. Clin Transplant. 2007 Nov-Dec;21(6):716-21 - PubMed
  73. J Hepatol. 2012 Jul;57(1):203-12 - PubMed
  74. Transplant Proc. 2003 Feb;35(1):354-5 - PubMed
  75. Transplant Proc. 2005 Nov;37(9):3899-903 - PubMed
  76. Dig Dis Sci. 2008 Nov;53(11):3012-7 - PubMed
  77. Gut. 2005 May;54(5):691-7 - PubMed
  78. Alcohol. 1998 Jan;15(1):19-23 - PubMed
  79. Clin Gastroenterol Hepatol. 2012 Jul;10 (7):776-83 - PubMed
  80. Transplant Proc. 2008 May;40(4):1183-6 - PubMed
  81. Chang Gung Med J. 2011 Jul-Aug;34(4):426-34 - PubMed
  82. Hepatology. 2005 Mar;41(3):553-8 - PubMed
  83. Am J Transplant. 2002 Nov;2(10):934-8 - PubMed
  84. Semin Thromb Hemost. 2010 Mar;36(2):170-4 - PubMed
  85. Gut. 2011 Jun;60(6):846-52 - PubMed

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