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Intern Emerg Med. 2016 Dec;11(8):1059-1066. Epub 2016 Mar 30.

Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry.

Author information

1
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.violi@uniroma1.it.
2
First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
3
Division of Gastroenterology and Hepatology, Digestive Health Center, University of Virginia, Charlottesville, VA, USA.
4
Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
5
Department of Medicine, University of Padova, Padua, Italy.
6
Liver Unit, University Hospital Tor Vergata, Rome, Italy.
7
Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy.
8
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.

Abstract

Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the "Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry" (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child-Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected portal vein thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the portal vein thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p < 0.001), Child-Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with portal vein thrombosis. Portal vein thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate-severe liver failure. The apparent undertreatment of patients with portal vein thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.

KEYWORDS:

Anticoagulants; Esophageal varices; Hepatocellular carcinoma; Liver failure; Splanchnic venous thrombosis

PMID:
27026379
DOI:
10.1007/s11739-016-1416-8
[Indexed for MEDLINE]

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