title: Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study.
abstract: BACKGROUND
  Portal vein thrombosis is a frequent complication in liver cirrhosis. Encouraging reports of systemic thrombolysis in non-cirrhotic patients suffering from acute portal vein thrombosis led us to start a pilot study on the efficacy and safety of systemic low dose recombinant tissue plasminogen activator (Actilyse, Boheringer Ingelheim, Florence, Italy).
  
  
  METHODS
  Nine cirrhotic patients (6 males and 3 females) with recent portal vein thrombosis were enrolled. Exclusion criteria were portal cavernomatosis, recent (30 days) surgery, active bleeding, hepatocellular carcinoma and cancer in other sites.
  
  
  METHODS
  All cases were treated for a maximum of 7 days by continuous i.v. infusion of 0.25mg/kg/die of r-tPA plus subcutaneous low molecular weight heparin. Efficacy was evaluated by colour doppler sonography monitoring and confirmed by contrast enhanced computerized tomography.
  
  
  RESULTS
  The combined r-tPA/LMWH treatment was well tolerated without clinically significant side effects. Complete resolution of thrombosis occurred in 4 cases, partial regression in 4 and none in 1. Retreatment of a complete recurrence in 1 patient was successful. Variceal pressure dropped from 30.7+/-4.5 mmHg to 21.2+/-6.6 mmHg (p=0.012).
  
  
  CONCLUSIONS
  Our preliminary data demonstrate that thrombolytic treatment of recent portal vein thrombosis with i.v. r-tPA and LMWH in patients with cirrhosis appears to be safe and effective and can significantly reduce pressure in oesophageal varices.
authors.affiliation: GI Unit, Department of Clinical Medicine, University of Rome La Sapienza, Rome, Italy. adsdmc@tin.it
authors.forename: Adriano
authors.initials: A
authors.lastname: De Santis
authors.forename: Rosanna
authors.initials: R
authors.lastname: Moscatelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Gigliotti
authors.forename: Francesca
authors.initials: F
authors.lastname: Cristofari
authors.forename: Silvia
authors.initials: S
authors.lastname: Trapani
authors.forename: Adolfo F
authors.initials: AF
authors.lastname: Attili
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011169:Portal Vein; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014690:Venous Pressure / Q000187:drug effects; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010959:Tissue Plasminogen Activator