title: Splanchnic vein thrombosis and variceal rebleeding in patients with cirrhosis.
abstract: OBJECTIVE
  Splanchnic vein thrombosis (SVT) affects the short-term prognosis of acute variceal bleeding in cirrhotic patients. This study evaluated whether SVT also affects the rebleeding rate of patients included in a program of secondary prophylaxis after variceal bleeding.
  
  
  METHODS
  A total of 387 patients with variceal bleeding were included from January 2001 to December 2010. Band ligation was carried out every 3-4 weeks. Follow-up included endoscopy at 1, 3, and every 6 months, Echo-Doppler, and biochemical examination every 6 months. From 2005, patients with SVT received anticoagulation with enoxaparin 200 UI/kg/day for at least 6 months. The therapy was started after variceal eradication.
  
  
  RESULTS
  SVT was diagnosed in 41 patients at variceal bleeding, in eight before and in 18 patients during the follow-up. Variceal eradication was achieved in 89.2 and 86.6% in no-SVT and SVT patients. Rebleeding occurred in 9.5 and 11.9% of no-SVT and SVT patients at 12 months. Varices relapsed more frequently in SVT than in no-SVT patients (25.4 vs. 14.67%, P=0.03). The rates of variceal rebleeding and relapse were similar in patients who received or did not receive anticoagulation, but mortality was significantly lower in patients who received anticoagulation.
  
  
  CONCLUSIONS
  SVT favors the relapse of esophageal varices, but rebleeding can be effectively prevented by standard scheduled band ligations. Anticoagulation does not prevent variceal relapse. The improvement in the survival of patients treated with anticoagulation needs to be confirmed in future studies.
authors.affiliation: Gastroenterology Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Amitrano
authors.forename: Maria A
authors.initials: MA
authors.lastname: Guardascione
authors.forename: Mariano
authors.initials: M
authors.lastname: Scaglione
authors.forename: Antonella
authors.initials: A
authors.lastname: Menchise
authors.forename: Rossana
authors.initials: R
authors.lastname: Martino
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Alfonso G
authors.initials: AG
authors.lastname: Lanza
authors.forename: Filippo
authors.initials: F
authors.lastname: Lampasi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D017984:Enoxaparin / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin