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- Title
Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function.
- Authors
Scheiner, Bernhard; Stammet, Paul René; Pokorny, Sebastian; Bucsics, Theresa; Schwabl, Philipp; Brichta, Andrea; Thaler, Johannes; Lampichler, Katharina; Ba-Ssalamah, Ahmed; Ay, Cihan; Ferlitsch, Arnulf; Trauner, Michael; Mandorfer, Mattias; Reiberger, Thomas
- Abstract
Background: Non-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis.Aim: We retrospectively assessed the course of non-malignant PVT in patients receiving AC.Methods: Parameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented.Results: Among 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (≥9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; p = 0.08) and lower progression rates of 25% (vs. 42% without AC; p = 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (n = 39), long-term AC (n = 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, p = 0.031). Interestingly, AST/ALT tended to decrease (−19%/−16%) and the proportion of patients with ascites became lower (−33%) with long-term AC (without AC: ±0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6 g/dl) when compared to patients without long-term AC (−2%/−0.8 g/dl; p = 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%).Conclusion: Our findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.
- Subjects
PORTAL vein diseases; THROMBOSIS; ANTICOAGULANTS; CIRRHOSIS of the liver; DISEASE progression; PATIENTS
- Publication
Wiener Klinische Wochenschrift, 2018, Vol 130, Issue 13/14, p446
- ISSN
0043-5325
- Publication type
Article
- DOI
10.1007/s00508-018-1351-y