title: Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis.
abstract: OBJECTIVE
  Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there are limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT.
  
  
  METHODS
  We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n = 31) or progression of previously known PVT (n = 24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed, and recanalization was evaluated by using Doppler ultrasound, angio-computed tomography, and/or angio-magnetic resonance imaging analyses.
  
  
  RESULTS
  Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed less frequent liver-related events (portal hypertension-related bleeding, ascites, or hepatic encephalopathy) during the follow-up period, but this difference was not statistically significant (P = .1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50 × 109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy.
  
  
  CONCLUSIONS
  Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clínic-Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: María Gabriela
authors.initials: MG
authors.lastname: Delgado
authors.forename: Susana
authors.initials: S
authors.lastname: Seijo
authors.forename: Ismael
authors.initials: I
authors.lastname: Yepes
authors.forename: Linette
authors.initials: L
authors.lastname: Achécar
authors.forename: Maria Vega
authors.initials: MV
authors.lastname: Catalina
authors.forename: Angeles
authors.initials: A
authors.lastname: García-Criado
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Joaquín
authors.initials: J
authors.lastname: de la Peña
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001368:Axis, Cervical Vertebra; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants