ORIGINAL ARTICLE   

Minerva Gastroenterology 2023 March;69(1):107-13

DOI: 10.23736/S2724-5985.21.02861-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Treatment of portal vein thrombosis in cirrhosis: a multicenter real life cοhort study

Aikaterini MANTAKA ¹ ✉, Nikolaos GATSELIS ², Christos K. TRIANTOS ³, Ulrich THALHEIMER ⁴, Gioacchino LEANDRO ⁵, Kalliopi ZACHOU ², Christos KONSTANTAKIS ³, Asterios SAITIS ², Konstantinos THOMOPOULOS ³, Elias A. KOUROUMALIS ¹, George N. DALEKOS ², Dimitrios N. SAMONAKIS ¹

¹ Department of Gastroenterology & Hepatology, University Hospital of Heraklion, Heraklion, Crete, Greece; ² Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; ³ Department of Gastroenterology, University Hospital of Patras, Patras, Greece; ⁴ Department of Gastroenterology, Royal Shrewsbury Hospital, Shrewsbury, UK; ⁵ Department of Gastroenterology, IRCCS Saverio De Bellis Hospital, Castellana Grotte, Bari, Italy

BACKGROUND: Portal vein thrombosis (PVT) is a common complication of cirrhosis and can be a cause or consequence of liver disease progression. It is unclear whether PVT treatment is affecting clinical outcomes in cirrhotics.
METHODS: This is a multicenter study of cirrhotics with PVT, initially retrospectively and thereafter prospectively registered in a data base. We studied the impact of PVT treatment on this population for efficacy, safety and the impact on survival. In survival analysis Mantel-Cox and Wilcoxon-Breslow-Gehan tests were used. A P value of <0.05, was considered significant. For statistical computations the STATA 12.1 was used.
RESULTS: Seventy-six patients were included (76% decompensated, median MELD score 12 and Child-Pugh score 7), 47% with concomitant HCC. Fifty-one patients with PVT were treated with Vitamin-K antagonists or Low-Molecular-Weight Heparin. Patients were followed up for at least 6 months after PVT diagnosis, or until death or transplantation. PV patency after 6 months was not statistically different between patients receiving or not anticoagulation (complete-partial recanalization 27.4% of treated vs. 20% of untreated, P=0.21). Median survival was statistically worse between patients treated with anticoagulation than those untreated (10 vs. 15 months, P=0.036). Less portal hypertensive bleeding and less decompensation rates were found in treated cirrhotics vs. untreated (45.8% vs. 54.2%, P=0.003 and 78% vs. 80.9%, P=0.78, respectively). Patients with HCC had worse survival when treated vs. untreated (P=0.047).
CONCLUSIONS: In our cohort of cirrhotics with PVT, treatment was feasible with acceptable side effects, but without meaningful clinical benefits.

KEY WORDS: Thrombosis; Hemorrhage; Liver cirrhosis; Safety; Heparin, low-molecular-weight; Survival