title: Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis.
abstract: BACKGROUND
  There is no established management algorithm for portal vein thrombosis (PVT) in cirrhotic patients. The aim of our study was to prospectively evaluate anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) to treat PVT.
  
  
  METHODS
  Cirrhotics with non-malignant PVT were included. Low weight molecular heparin anticoagulation was considered in all; TIPS was indicated if thrombosis progressed or anticoagulation was contraindicated. Patients who were not anticoagulated nor received TIPS served as controls.
  
  
  RESULTS
  Fifty-six patients (of whom 21 controls) were included. PVT was occlusive in 11/35, with extension to the superior mesenteric or splenic vein in 13/35. In the study group 33 patients were anticoagulated, with a recanalization rate of 36% (12/33) compared with 1/21 among controls. A time interval between appearance of thrombosis and anticoagulation < 6 months predicted chance of repermeation. Thrombus progression occurred in 15/21 non anticoagulated patients and in 5/33 anticoagulated patients (P < 0.001). TIPS was placed in six patients. There were five variceal bleedings and two intestinal venous ischaemia episodes in the control group, compared with one variceal bleeding episode in the study group.
  
  
  CONCLUSIONS
  In cirrhotics with PVT, a treatment algorithm using anticoagulation and TIPS achieves a good chance of complete repermeation, reduces portal hypertensive complications, and decreases the rate of thrombosis progression.
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy. marcosenzolo@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.forename: Teresa
authors.initials: T
authors.lastname: M Sartori
authors.forename: Valeria
authors.initials: V
authors.lastname: Rossetto
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boccagni
authors.forename: Daniele
authors.initials: D
authors.lastname: Gasparini
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: Kenneth
authors.initials: K
authors.lastname: A Burroughs
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight