title: Emergency anticoagulation treatment for cirrhosis patients with portal vein thrombosis and acute variceal bleeding.
abstract: OBJECTIVE
  To determine the safety and efficacy of anticoagulation treatment for portal vein thrombosis in cirrhosis patients with acute variceal bleeding, with patient eligibility determined by contrast ultrasonography findings.
  
  
  METHODS
  This prospective study included 23 consecutive cirrhosis patients (63.8 ± 11.8 years old, 12 males and 11 females) with emergency admission for acute variceal bleeding with or without portal vein thrombus. Eligibility for anticoagulation treatment was determined by positive intra-thrombus enhancement on contrast ultrasonography (perflubutane microbubble agent, 0.0075 mL/kg) performed before endoscopy. Low-molecular-weight heparin was administered after hemostasis was achieved by band ligation. Repeated band ligation or injection sclerotherapy combined with argon plasma coagulation was performed for variceal disappearance.
  
  
  RESULTS
  Hemostasis was achieved in all 10 patients with active bleeding. Five of these patients had portal vein thrombus, and all showed positive intra-thrombus enhancement on contrast ultrasonography. Anticoagulation treatment of these five patients resulted in complete recanalization of the portal vein within 2-11 days. There were no significant differences in the number of endoscopic treatment sessions or the length of hospital stay between the groups with and without thrombosis, and no complications including rebleeding were reported. Long term, none of the patients who continued oral anticoagulation treatment had recurrence of thrombosis (4/5). Variceal recurrence occurred only in the non-thrombosis group (2/18) during the follow-up period (median: 351 days).
  
  
  CONCLUSIONS
  Early anticoagulation treatment in cirrhosis patients with portal vein thrombosis and acute variceal bleeding may be safe, tolerated, and effective in cases with positive intra-thrombus enhancement on contrast ultrasonography.
authors.affiliation: Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan. maru-cib@umin.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Takahashi
authors.forename: Taro
authors.initials: T
authors.lastname: Shimada
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D003287:Contrast Media; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000628:therapy; D005260:Female; D005290:Ferric Compounds; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000628:therapy; D006489:Hemostatic Techniques; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007501:Iron; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010087:Oxides; D010865:Pilot Projects; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D003287:Contrast Media; D005290:Ferric Compounds; D006495:Heparin, Low-Molecular-Weight; D010087:Oxides; C069727:Sonazoid; D007501:Iron