title: Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hopital Beaujon, Clichy, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Plessier
authors.forename: Sarwa
authors.initials: S
authors.lastname: Darwish-Murad
authors.forename: Manuel
authors.initials: M
authors.lastname: Hernandez-Guerra
authors.forename: Yann
authors.initials: Y
authors.lastname: Consigny
authors.forename: Federica
authors.initials: F
authors.lastname: Fabris
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.forename: Jorg
authors.initials: J
authors.lastname: Heller
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morard
authors.forename: Luc
authors.initials: L
authors.lastname: Lasser
authors.forename: Philippe
authors.initials: P
authors.lastname: Langlet
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Denninger
authors.forename: Dominique
authors.initials: D
authors.lastname: Vidaud
authors.forename: Bertrand
authors.initials: B
authors.lastname: Condat
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.forename: Massimo
authors.initials: M
authors.lastname: Primignani
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
authors.forename: Dominique
authors.initials: D
authors.lastname: Valla
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001201:Ascites / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D013162:Splenic Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000925:Anticoagulants