Gastroenterology

Gastroenterology

Volume 120, Issue 2, February 2001, Pages 490-497
Gastroenterology

Liver, Pancreas, and Biliary Tract
Current outcome of portal vein thrombosis in adults: Risk and benefit of anticoagulant therapy

https://doi.org/10.1053/gast.2001.21209Get rights and content

Abstract

Background & Aims: The outcome of portal vein thrombosis in relation to associated prothrombotic states has not been evaluated. We assessed current outcome and predictors of bleeding and thrombotic events in a cohort of 136 adults with nonmalignant, noncirrhotic portal vein thrombosis, of whom 84 received anticoagulant therapy. Methods: Multivariate Cox model analysis for event-free survival and analysis taking into account multiple events were used. Results: Median follow-up was 46 months. The incidence rate of gastrointestinal bleeding was 12.5 (95% confidence interval [CI], 10–15) per 100 patient-years. Large varices were an independent predictor for bleeding. Anticoagulant therapy did not increase the risk or the severity of bleeding. The incidence rate of thrombotic events was 5.5 (95% CI, 3.8–7.2) per 100 patient-years. Underlying prothrombotic state and absence of anticoagulant therapy were independent predictors for thrombosis. In patients with underlying prothrombotic state, the incidence rates of splanchnic venous infarction were 0.82 and 5.2 per 100 patient-years in periods with and without anticoagulant therapy, respectively (P = 0.01). Two nonanticoagulated patients died of bleeding and thrombosis, respectively. Conclusions: In patients with portal vein thrombosis, the risk of thrombosis is currently as clinically significant as the risk of bleeding. The benefit-risk ratio favors anticoagulant therapy.

GASTROENTEROLOGY 2001;120:490-497

Section snippets

Patients

All patients seen between 1983 and 1998 were enrolled if (1) they had been followed up at our institution; (2) portal venous thrombosis (endoluminal material and absence of flow in the portal vein or cavernous transformation of the vein) had been documented; (3) ongoing cancer had been excluded using all appropriate imaging and endoscopic procedures; (4) any kind of intrahepatic portal hypertension, including cirrhosis, had been excluded by normal liver function test results and normal aspect

Overall characteristics of the cohort

One hundred thirty-six patients were enrolled (74 men and 62 women). The median age at diagnosis of portal venous thrombosis was 43 years (range, 15–74 years). Initial manifestations were as follows: abdominal pain (n = 67), gastrointestinal bleeding related to portal hypertension (n = 24), mesenteric venous infarction (n = 7), ascites (n = 4), no clinical manifestations (i.e., fortuitous diagnosis; n = 10), and other clinical manifestations (n = 14). Portal venous thrombosis was demonstrated

Discussion

The natural history of portal vein thrombosis is unknown because in all reported cohorts of patients, some form of therapy has been administered for portal hypertension or thrombophilia. The rarity of portal vein thrombosis has not allowed controlled therapeutic trials to be conducted. Therefore, the influence of the various medical or surgical interventions remains ill-known. With these limitations as a background, the present survey has allowed re-evaluation of the outcome of portal vein

References (43)

  • L Pagliaro et al.

    Portal hypertension: diagnosis and treatment

    J Hepatol

    (1995)
  • B Bernard et al.

    Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis

    J Hepatol

    (1997)
  • SE Grauer et al.

    Extrahepatic portal hypertension: a retrospective analysis

    Ann Surg

    (1979)
  • F Cardin et al.

    Adult “idiopathic” extrahepatic venous thrombosis. Importance of putative “latent” myeloproliferative disorders and comparison with known etiology

    Dig Dis Sci

    (1992)
  • LJ Webb et al.

    The aetiology, presentation and natural history of extra-hepatic portal venous obstruction

    Q J Med

    (1979)
  • AB Voorhes et al.

    Extrahepatic portal hypertension. A retrospective analysis of 127 cases and associated clinical implications

    Arch Surg

    (1974)
  • F Cardot et al.

    Les syndromes d'ischémie veineuse mésentérique: infarctus et ischémie transitoire

    Gastroenterol Clin Biol

    (1992)
  • D Levoir et al.

    Une nouvelle cause héréditaire de thrombose portale: la résistance anormale à la protéine C activée par mutation Arg 506→Gln du gène du facteur V

    Gastroenterol Clin Biol

    (1995)
  • S Schneider et al.

    Thrombose veineuse portale et déficits constitutionnels en protéines de la coagulation

    Gastroenterol Clin Biol

    (1992)
  • D Valla et al.

    Portal vein thrombosis with ruptured œsophageal varices as presenting manifestation of hereditary protein C deficiency

    Gut

    (1988)
  • HM Harch et al.

    Pylethrombosis. Serendipitous radiologic diagnosis

    Arch Surg

    (1987)
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