Anticoagulation and Vessel Recanalization in Cirrhotic Patients with Splanchnic Vein Thrombosis: A Multidisciplinary "Real Life" Experience.

Autor:	Rupoli S; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Fiorentini A; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Morsia E; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Svegliati-Baroni G; SOD Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d'Urgenza, Ancona, Italy., Micucci G; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Maroni L; SOD Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d'Urgenza, Ancona, Italy., Garvey KB; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Fiorentini A; SOD Malattie Infettive emergenti e degli immunodepressi, Ospedali Riuniti Ancona, Ancona, Italy., Riva A; SOD Clinica Malattie Infettive tropicali, parassitologia, epatiti croniche, Ancona, Italy., Da Lio L; SOD Medicina di Laboratorio, Ospedali Riuniti Ancona, Ancona, Italy., Benedetti A; SOD Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d'Urgenza, Ancona, Italy., Offidani M; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Olivieri A; Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy., Giuseppe T; SOD Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d'Urgenza, Ancona, Italy.
Jazyk:	angličtina
Zdroj:	Vascular health and risk management [Vasc Health Risk Manag] 2021 Sep 24; Vol. 17, pp. 619-629. Date of Electronic Publication: 2021 Sep 24 (Print Publication: 2021).
DOI:	10.2147/VHRM.S310615
Abstrakt:	Background and Aim: Splanchnic vein thrombosis (SVT) is a potentially life-threatening complication of liver cirrhosis. This study aimed to evaluate the impact of a multi-disciplinary approach and early anticoagulation therapy (AT) on bleeding/thrombotic events, recanalization rates and outcome of cirrhotic patients with SVT. Methods: This is a single-center, registry-based cohort study. Over 17 years, 149 SVT patients were enrolled and prospectively evaluated. Regarding cirrhotic-SVT, a pre-specified algorithm, guiding initial posology of AT and follow-up visits schedule, was performed. Major bleeding (MB), thrombotic events, functional liver scores and all cause-mortality were investigated. Efficacy of AT was evaluated by radiological imaging. Results: In cirrhotic-SVT, the incidence rate of MB was 8.4 per 100 patient-year (95% CI, 3.83-15.97), while the incidence rate of thrombosis was 5.6 per 100 patient-year (95% CI, 2.05-12.2). In incidental SVT treated with AT, MB incidence was 6.5 per 100 patient-year (95% CI: 2.8-12.82), while in symptomatic SVT was 2.2 per 100 patient-year (95% CI: 0.25-8.02). All thrombotic recurrences occurred in incidental SVT (7.7 per 100 patient-years; 95% CI, 3.71-14.26). Overall survival was significantly higher in patients who had at least a partial recanalization (p < 0.01) and partial/total recanalization was independently associated with improved MELD score at multivariate analysis (HR 2.62, 95% CI 1.1-6.47, p = 0.03). Conclusion: In cirrhotic SVT patients, partial or total resolution of thrombosis ameliorates liver function and is associated with higher overall survival. A multidisciplinary approach together with radiological follow-up at pre-fixed time improves patient selection and monitoring. Competing Interests: No conflict of interest for any of the authors. The authors did not receive any financial support. All the authors designed the study, contributed patients, helped abstract patient information, performed statistical analysis, and wrote the paper. (© 2021 Rupoli et al.)
Databáze:	MEDLINE
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