Clinical Impact and Safety of Anticoagulants for Portal Vein Thrombosis in Cirrhosis
| Autor: | Pettinari I., Vukotic R., Stefanescu H., Pecorelli A., Morelli M., Grigoras C., Sparchez Z., Andreone P., Piscaglia F., Badia L., Cappelli A., Cescon M., Conti F., Cucchetti A., GALAVERNI, CRISTINA, Golfieri R., Granito A., Mosconi C., Renzulli M., Tame M., Verucchi G., Vitale G., Bolondi L. |
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| Přispěvatelé: | Pettinari I., Vukotic R., Stefanescu H., Pecorelli A., Morelli M., Grigoras C., Sparchez Z., Andreone P., Piscaglia F., Badia L., Cappelli A., Cescon M., Conti F., Cucchetti A., Galaverni C., Golfieri R., Granito A., Mosconi C., Renzulli M., Tame M., Verucchi G., Vitale G., Bolondi L. |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Cirrhosis genetic structures Portal vein Hemorrhage Esophageal and Gastric Varices behavioral disciplines and activities 03 medical and health sciences 0302 clinical medicine Hypertension Portal mental disorders medicine Humans anticoagulation Aged Venous Thrombosis Hepatology Portal Vein business.industry Portal vein thrombosis bleeding portal hypertension Gastroenterology Anticoagulants Heparin Portal vein thrombosis anticoagulation bleeding portal hypertension Heparin Low-Molecular-Weight Middle Aged medicine.disease Surgery Large cohort Fondaparinux Anticoagulant therapy 030220 oncology & carcinogenesis Portal hypertension Female 030211 gastroenterology & hepatology Gastrointestinal Hemorrhage business Complication human activities psychological phenomena and processes medicine.drug |
| Popis: | Objectives: Portal vein thrombosis (PVT) is a frequent complication of cirrhosis. Benefit, safety, and duration of anticoagulant treatment in this setting are controversial issues. The aim of this study was to analyze the course of PVT in a large cohort of cirrhotic patients undergoing or not anticoagulation therapy. Methods: The data of 182 patients who presented between January 2008 and March 2016 with cirrhosis and PVT with at least 3 months of follow-up after the first PVT detection were analyzed. Eighty-one patients received anticoagulants and 101 were untreated per physician discretion. Results: The extension of the thrombosis decreased by >50% in 46 (56.8%, with complete recanalization in 31/46) patients under anticoagulation and in 26 (25.7%) untreated patients. Of the 46 patients who underwent recanalization, 17 (36%) suffered recurrent thrombosis after stopping anticoagulation therapy. Kaplan–Meier analysis showed a higher survival rate in the treated group (p = 0.010). At multivariate analysis, anticoagulation was an independent factor associated with longer survival (HR:0.30, CI:0.10–0.91, p = 0.014). The Child–Turcotte–Pugh classes B/C negatively influenced survival (hazard ratio, (HR):3.09, confidence interval (CI):1.14–8.36, p = 0.027 for Child–Turcotte–Pugh B and HR:9.27, CI:2.67–32.23, p < 0.001 for Child–Turcotte–Pugh C). Bleeding complications occurred in 22 (21.8%) untreated and 16 (19.7%) treated patients, but in only four cases was it judged to be related to the anticoagulant treatment. No death was reported as a consequence of the bleeding events. Conclusions: Anticoagulant treatment is a safe and effective treatment leading to partial or complete recanalization of the portal venous system in 56.8% of cases, improving the survival of patients with cirrhosis and PVT. Discontinuation of the therapy is associated with a high rate of PVT recurrence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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