Liver Failure/Cirrhosis/Portal Hypertension

You have full text access to this OnlineOpen article

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

  1. Aurelie Plessier1,
  2. Sarwa Darwish-Murad2,
  3. Manuel Hernandez-Guerra3,
  4. Yann Consigny1,
  5. Federica Fabris4,
  6. Jonel Trebicka5,
  7. Jorg Heller5,
  8. Isabelle Morard6,
  9. Luc Lasser7,
  10. Philippe Langlet7,
  11. Marie-Hélène Denninger8,
  12. Dominique Vidaud8,
  13. Bertrand Condat1,
  14. Antoine Hadengue6,
  15. Massimo Primignani4,
  16. Juan-Carlos Garcia-Pagan3,
  17. Harry L. A. Janssen2,
  18. Dominique Valla1,‡,*,
  19. European Network for Vascular Disorders of the Liver (EN-Vie)§

Article first published online: 31 AUG 2009

DOI: 10.1002/hep.23259

Issue

Hepatology

Hepatology

Volume 51, Issue 1, pages 210–218, January 2010

Additional Information

How to Cite

Plessier, A., Darwish-Murad, S., Hernandez-Guerra, M., Consigny, Y., Fabris, F., Trebicka, J., Heller, J., Morard, I., Lasser, L., Langlet, P., Denninger, M.-H., Vidaud, D., Condat, B., Hadengue, A., Primignani, M., Garcia-Pagan, J.-C., Janssen, H. L. A., Valla, D. and European Network for Vascular Disorders of the Liver (EN-Vie) (2010), Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study. Hepatology, 51: 210–218. doi: 10.1002/hep.23259

Author Information

  1. 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

  2. 2

    Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

  3. 3

    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

  4. 4

    Gastroenterology 3 Unit, Department of Medical Sciences, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy

  5. 5

    Department of Internal Medicine I, University of Bonn, Bonn, Germany

  6. 6

    Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland

  7. 7

    Department of Hepatogastroenterology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

  8. 8

    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

  1. ‡

    fax: (33)-1-40-87-44-26.

  2. §

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

*Service d'Hépatologie, Hŏpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France

  1. †

    Potential conflict of interest: Nothing to report.

Publication History

  1. Issue published online: 23 DEC 2009
  2. Article first published online: 31 AUG 2009
  3. Accepted manuscript online: 31 AUG 2009 12:00AM EST
  4. Manuscript Accepted: 24 AUG 2009
  5. Manuscript Received: 13 JAN 2009

Funded by

  • European Union 5th Frame Work Program with public funding from GIS-Maladies Rares (France, 2001). Grant Number: QLG1-CT-2002-01686
  • Centro de Investigación Biomedica en Red de Enfermedades Hepaticas y Digestivas is funded by Instituto de Salud Carlos III
  • Clinical Fellow of The Netherlands Organization for Scientific Research Center of biomedical, hepatology and digestive investigation

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (502K)

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.)

View Full Article (HTML) Get PDF (502K)