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

• Published in: Minerva gastroenterology Vol. 69; no. 1; p. 107
• Main Authors: Mantaka, Aikaterini, Gatselis, Nikolaos, Triantos, Christos K, Thalheimer, Ulrich, Leandro, Gioacchino, Zachou, Kalliopi, Konstantakis, Christos, Saitis, Asterios, Thomopoulos, Konstantinos, Kouroumalis, Elias A, Dalekos, George N, Samonakis, Dimitrios N
• Format: Journal Article
• Language: English
• Published: Italy 01.03.2023
• Subjects: Carcinoma, Hepatocellular - complications; Humans; Liver Cirrhosis - complications; Liver Neoplasms - complications; Portal Vein; Retrospective Studies; Thrombosis
• ISSN: 2724-5365

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. 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. 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). In our cohort of cirrhotics with PVT, treatment was feasible with acceptable side effects, but without meaningful clinical benefits.