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.


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.
Plessier
Aurelie
A
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.
Darwish-Murad
Sarwa
S
Hernandez-Guerra
Manuel
M
Consigny
Yann
Y
Fabris
Federica
F
Trebicka
Jonel
J
Heller
Jorg
J
Morard
Isabelle
I
Lasser
Luc
L
Langlet
Philippe
P
Denninger
Marie-Hélène
MH
Vidaud
Dominique
D
Condat
Bertrand
B
Hadengue
Antoine
A
Primignani
Massimo
M
Garcia-Pagan
Juan-Carlos
JC
Janssen
Harry L A
HL
Valla
Dominique
D
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*
D000925:Anticoagulants