Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation.
OBJECTIVE
Acute portal vein thrombosis (APVT) is a rare disorder that causes chronic portal hypertension if recanalization is not obtained. However, response to anticoagulation and long-term prognosis of APVT are not well-defined.


METHODS
Thirty-eight patients diagnosed with APVT between 1995 and 2003 from 5 Spanish referral hospitals, in whom cirrhosis and malignancy were specifically excluded, were included in this retrospective study. The response to anticoagulation therapy and development of portal hypertension-related complications during follow-up were evaluated.


RESULTS
Mean follow-up was 43 months (range, 6-112 months). Recanalization occurred in 12 of 27 patients receiving anticoagulation versus 0 of 11 patients who did not receive anticoagulation (P = .008). Rates of recanalization were influenced by the precocity of heparin administration and the number of underlying prothrombotic conditions. Follow-up upper endoscopy performed in 29 patients disclosed gastroesophageal varices in 16 (55%). Varices appeared as early as 1 month after APVT. However, in most patients varices were detected in successive endoscopies, mainly during the first year. Two-year actuarial probability of variceal bleeding was 12% and for ascites 16%. Five-year survival was 87%. Mortality was related to the APVT episode in 2 cases and to an underlying hematologic disorder in one.


CONCLUSIONS
Anticoagulation achieved recanalization in about 40% of patients. Most patients not achieving recanalization will develop gastroesophageal varices during follow-up. However, development of variceal bleeding and ascites is infrequent, and survival is satisfactory.
Turnes
Juan
J
Hepatic Hemodynamic Laboratory,Institut Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
García-Pagán
Juan Carlos
JC
González
Monica
M
Aracil
Carles
C
Calleja
José Luís
JL
Ripoll
Cristina
C
Abraldes
Juan G
JG
Bañares
Rafael
R
Villanueva
Cándido
C
Albillos
Agustín
A
Ayuso
Juan Ramón
JR
Gilabert
Rosa
R
Bosch
Jaime
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
D000925:Anticoagulants