Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis

We read with great interest the recent publication by La Mura et  al1 that focused on the potential beneficial role of anticoagulants in the treatment of portal vein thrombosis (PVT) in cirrhotic patients. The investigators concluded that vitamin k anticoagulants (VKA) is highly effective in portal recanalization, without any evidence of an increased risk of ble eding, compared with untreated cirrhotic patients. In addition, La Mura et al1 successfully showed that achieving a complete recanalization of portal vein thrombosis (PVT) with VKA is associated with a significant reduction in the long-term risk of portal hypertension-related complication and death and/or need for a liver transplant.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research

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AbstractBackgroundThe role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial.AimsWe analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival.MethodsEighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis.ResultsAverage MELD score was 15  ± 7. Portal hypertension-related complications at PVT diagnosis were present i...
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
AbstractNon-tumoral portal vein thrombosis (PVT) remains a highly relevant topic in the field of hepatology and liver transplantation with much surrounding controversy. Although multiple studies have shown that PVT is associated with adverse outcomes with increased morbidity and mortality rates, others have not reported the same clinical impact of PVT, arguing rather that incident PVT reflects worsening portal hypertension and the natural history of the disease. Despite this uncertainly, PVT is a dilemma facing the clinician on a daily basis often requiring a multidisciplinary team-based approach between hepatologists, tra...
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
CONCLUSIONS: HPS is associated with intrahepatic vascular changes and with features suggesting severe portal hypertension. These results raise the hypothesis that intrahepatic vascular changes precipitate the development of HPS, opening new therapeutic perspectives for HPS. PMID: 30292761 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
This article aims to review management of portal hypertension in children as it pertains to the interventional radiologist, including preoperative assessment, postoperative evaluation, and the management of complications of the Meso-Rex bypass. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Seminars in Interventional Radiology - Category: Radiology Authors: Tags: Review Article Source Type: research
Purpose of review To describe portal vein thrombosis (PVT) in the setting of cirrhosis especially in relation to its potential impact on liver transplantation. In addition, the safety and efficacy of anticoagulation is reviewed. Recent findings PVT in cirrhosis occurs in up to 26% of patients awaiting liver transplantation. Different studies have suggested that PVT impacts negatively post-liver transplantation survival, particularly in first year post-liver transplantation and when PVT is complete involving the porto-mesenteric confluence and not allowing physiological anastomosis. Anticoagulation is effective in prev...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: CONTROVERSIES IN ORGAN TRANSPLANTATION: Edited by Norah A. Terrault Source Type: research
Pulmonary vascular disease is an important complication of portosystemic shunting in children and adults with chronic liver diseases and cirrhosis, extrahepatic portal vein obstruction/thrombosis or congenital portosystemic shunts (CPSSs).1 Two major types of pulmonary vascular disease in this context are hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH),1 both of which may indicate the need for liver transplantation.2 The hallmark of HPS is intrapulmonary vascular dilatation (IPVD) and shunting leading to an increased alveolar-arterial gradient and, generally, hypoxemia (Table  I).
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Medical progress Source Type: research
We report the clinical case of 23-year-old patient with liver cirrhosis of unknown genesis, significant resistant ascites, and 2 episodes of bleeding from esophageal varices. Evaluation did not find any cause of liver disease, and the patient was placed on the transplant wait list due to subcompensated liver function (Model for End-Stage Liver Disease score of 16, Child-Pugh class B) and poorly controlled severe portal hypertension. After treatment with diuretics, largevolume paracentesis, antibiotics, and vasoconstrictors, hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved sign...
Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation - Category: Transplant Surgery Authors: Tags: Exp Clin Transplant Source Type: research
a-Pagán JC Abstract PURPOSE OF REVIEW: To describe portal vein thrombosis (PVT) in the setting of cirrhosis especially in relation to its potential impact on liver transplantation. In addition, the safety and efficacy of anticoagulation is reviewed. RECENT FINDINGS: PVT in cirrhosis occurs in up to 26% of patients awaiting liver transplantation. Different studies have suggested that PVT impacts negatively post-liver transplantation survival, particularly in first year post-liver transplantation and when PVT is complete involving the porto-mesenteric confluence and not allowing physiological anastomosis...
Source: Current Opinion in Organ Transplantation - Category: Transplant Surgery Authors: Tags: Curr Opin Organ Transplant Source Type: research
The hemostatic environment in patients with cirrhosis is a delicate balance between prohemostatic and antihemostatic factors. There is a lack of effective laboratory measures of the hemostatic system in patients with cirrhosis. Many are predisposed to pulmonary embolus, deep vein thrombosis, and portal vein thrombosis in the pretransplantation setting. This pretransplantation hypercoagulable milieu seems to extend for at least several months post-transplantation. Patients with nonalcoholic fatty liver disease, inherited thrombophilia, portal hypertension in the absence of cirrhosis, and hepatocellular carcinoma often requi...
Source: Clinics in Liver Disease - Category: Gastroenterology Authors: Source Type: research
Authors: Stine JG, Argo CK, Pelletier SJ, Maluf DG, Caldwell SH, Northup PG Abstract AIM: To examine if liver transplant recipients with high-risk non-alcoholic steatohepatitis (NASH) are at increased risk for pre-transplant portal venous thrombosis. METHODS: Data on all liver transplants in the United States from February 2002 through September 2014 were analyzed. Recipients were sorted into three distinct groups: High-risk (age> 60, body mass index> 30 kg/m(2), hypertension and diabetes), low-risk and non-NASH cirrhosis. Multivariable logistic regression models were constructed. RESULTS: Thirty-five...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
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