Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study.
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.
De Santis
Adriano
A
GI Unit, Department of Clinical Medicine, University of Rome La Sapienza, Rome, Italy. adsdmc@tin.it
Moscatelli
Rosanna
R
Catalano
Carlo
C
Iannetti
Antonio
A
Gigliotti
Francesca
F
Cristofari
Francesca
F
Trapani
Silvia
S
Attili
Adolfo F
AF
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
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010959:Tissue Plasminogen Activator