Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study

Authors

  • Aurelie Plessier,

    1. Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hŏpital Beaujon, Clichy, France
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  • Sarwa Darwish-Murad,

    1. Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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  • Manuel Hernandez-Guerra,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi I Sunyer and Centro de Investigación Biomedica en Red de Enfermedades Hepaticas y Digestivas, Barcelona, Spain
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  • Yann Consigny,

    1. Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hŏpital Beaujon, Clichy, France
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  • Federica Fabris,

    1. Gastroenterology 3 Unit, Department of Medical Sciences, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy
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  • Jonel Trebicka,

    1. Department of Internal Medicine I, University of Bonn, Bonn, Germany
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  • Jorg Heller,

    1. Department of Internal Medicine I, University of Bonn, Bonn, Germany
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  • Isabelle Morard,

    1. Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland
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  • Luc Lasser,

    1. Department of Hepatogastroenterology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
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  • Philippe Langlet,

    1. Department of Hepatogastroenterology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
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  • Marie-Hélène Denninger,

    1. Service d'Hématologie Biologique et Laboratoire de Biochimie, Pŏle BIP, AP-HP, Université Denis Diderot-Paris 7 et Université Descartes-Paris 5, Hŏpital Beaujon, Clichy, France
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  • Dominique Vidaud,

    1. Service d'Hématologie Biologique et Laboratoire de Biochimie, Pŏle BIP, AP-HP, Université Denis Diderot-Paris 7 et Université Descartes-Paris 5, Hŏpital Beaujon, Clichy, France
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  • Bertrand Condat,

    1. Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hŏpital Beaujon, Clichy, France
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  • Antoine Hadengue,

    1. Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland
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  • Massimo Primignani,

    1. Gastroenterology 3 Unit, Department of Medical Sciences, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy
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  • Juan-Carlos Garcia-Pagan,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi I Sunyer and Centro de Investigación Biomedica en Red de Enfermedades Hepaticas y Digestivas, Barcelona, Spain
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  • Harry L. A. Janssen,

    1. Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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  • Dominique Valla,

    Corresponding author
    1. Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hŏpital Beaujon, Clichy, France
    • Service d'Hépatologie, Hŏpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France
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    • fax: (33)-1-40-87-44-26.

  • European Network for Vascular Disorders of the Liver (EN-Vie)

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    • A complete list of EN-Vie investigators and study investigators appears in the Appendix.


  • Potential conflict of interest: Nothing to report.

Abstract

Current recommendations for early anticoagulation in acute portal vein thrombosis unrelated to cirrhosis or malignancy are based on limited evidence. The aim of this study was to prospectively assess the risk factors, outcome, and prognosis in patients managed according to these recommendations. We enrolled 102 patients with acute thrombosis of the portal vein, or its left or right branch. Laboratory investigations for prothrombotic factors were centralized. Thrombus extension and recanalization were assessed by expert radiologists. A local risk factor was identified in 21% of patients, and one or several general prothrombotic conditions in 52%. Anticoagulation was given to 95 patients. After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and the superior mesenteric vein in 73% (versus 42% initially). Failure to recanalize the portal vein was independently related to the presence of ascites (hazard ratio 3.8, 95% confidence interval 1.3-11.1) and an occluded splenic vein (hazard ratio 3.5, 95% confidence interval 1.4–8.9). Gastrointestinal bleeding and intestinal infarction occurred in nine and two patients, respectively. Two patients died from causes unrelated to thrombosis or anticoagulation therapy. Conclusion: Recanalization occurs in one-third of patients receiving early anticoagulation for acute portal vein thrombosis, whereas thrombus extension, intestinal infarction, severe bleeding, and death are rare. Alternative therapy should be considered when ascites and splenic vein obstruction are present. (HEPATOLOGY 2009.)

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