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      Etiology and Complications of Portal Vein Thrombosis

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          Abstract

          Background

          Portal venous occlusion represents a disorder with considerable clinical relevance. The underlying causes of portal vein thrombosis (PVT) are frequently multifactorial and include malignancies, progressive chronic liver diseases, processes localized to the epigastrium and hepatobiliary system, and acquired as well as inherited thrombophilia. The three main categorical groups are malignant thrombosis, cirrhotic PVT, and non-malignant, non-cirrhotic PVT.

          Methods

          Review of the literature.

          Results

          The site, the extent, its chronicity, and the course of thromboses characterize a relatively heterogeneous clinical presentation and the ensuing complications in affected patients. While the occlusion of the extrahepatic portal and splenic vein likely provokes mainly complications related to portal hypertension, mesenteric venous obstruction shows a high rate of complications and mortality due to intestinal infarction. Especially in patients with liver cirrhosis, special care is warranted with regard to PVTs due to their pathogenetic role and influence on patient survival.

          Conclusion

          This article aims to summarize the current opinion on etiologies, risk factors, and complications of this heterogeneous condition in adults.

          Zusammenfassung

          Hintergrund

          Die Pfortaderthrombose ist ein relevantes klinisches Ereignis mit einer heterogenen und häufig multifaktoriellen Ätiologie. Die zugrunde liegenden Ursachen reichen von Malignomen über chronische Lebererkrankungen und periportale Prozesse bis hin zu erworbener und vererbter Thrombophilie. Als ätiologische Hauptgruppen werden die malignen, die zirrhotischen und die nichtmalignen, nichtzirrhotischen Thrombosen unterschieden.

          Methoden

          Literaturübersicht.

          Ergebnisse

          Die genaue Lokalisation, die Ausdehnung und der Verlauf der Thrombose entscheiden über die oft heterogenen klinischen Verläufe und Komplikationen bei diesen Patienten. Während die Thrombose der extrahepatischen Pfortader und Milzvene eher zu Komplikationen verbunden mit portalem Hypertonus führen, können Thrombosen der mesenterialen Venen eine hohe Rate an Komplikationen und Mortalität aufgrund einer mesenterialen Infarzierung bedingen. Vor allem bei Patienten mit einer Leberzirrhose ist besondere Vorsicht geboten, da die Pfortaderthrombose eine pathogenetische Rolle spielt und das Überleben beeinflusst.

          Schlussfolgerung

          Diese Übersichtsarbeit fasst die derzeitige Meinung bezüglich der Ätiologie, der Risikofaktoren und der Komplikationen dieser heterogenen Erkrankung bei Erwachsenen zusammen.

          Related collections

          Most cited references55

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          Vascular disorders of the liver.

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            Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study.

            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. 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.
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              Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.

              Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients. One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression. The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development. Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.
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                Author and article information

                Journal
                Viszeralmedizin
                Viszeralmedizin
                VIM
                Viszeralmedizin
                S. Karger Verlag für Medizin und Naturwissenschaften GmbH (Wilhelmstrasse 20A, P.O. Box · Postfach · Case postale, D–79095, Freiburg, Germany · Deutschland · Allemagne, Phone: +49 761 45 20 70, Fax: +49 761 4 52 07 14, information@karger.de )
                1662-6664
                1662-6672
                December 2014
                5 December 2014
                1 December 2015
                : 30
                : 6
                : 375-380
                Affiliations
                Department of Internal Medicine I, University of Bonn, Bonn, Germany
                Author notes
                *PD Dr. Dr. Jonel Trebicka, Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany, jonel.trebicka@ 123456ukb.uni-bonn.de
                Article
                vim-0030-0375
                10.1159/000369987
                4513836
                26288604
                5d954336-dca4-4431-9859-dd0534a0b30c
                Copyright © 2014 by S. Karger GmbH, Freiburg
                History
                Page count
                Figures: 1, Tables: 3, References: 53, Pages: 6
                Categories
                Review Article • Übersichtsarbeit

                portal vein thrombosis,malignancy,cirrhosis,myeloproliferative neoplasm,thrombophilia

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