title: Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count.
abstract: OBJECTIVE
  Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO) have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included), and to assess the effect of BRTO on platelet count over a 1-year period.
  
  
  METHODS
  This is a retrospective review of 35 patients who underwent BRTO (March 2008-August 2011). Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma) were analyzed (multivariate analysis). A total of 91% (n = 32/35) of patients had thrombocytopenia (<150,000 platelet/cm(3)) pre-BRTO. Platelet counts at within 48-h, within 2 weeks and at 30-60 days intervals (up to 6 months) after BRTO were compared with the baseline pre-BRTO values.
  
  
  RESULTS
  35 Patients with adequate platelet follow-up were found. A total of 92% and 17% of patients had a platelet count of <150,000/cm(3) and <50,000/cm(3), respectively. There was a trend for transient worsening of thrombocytopenia immediately (<48 h) after BRTO, however, this was not statistically significant. Platelet count was not a predictor of post-BRTO rebleeding or patient survival. However, MELD-score, albumin, international normalized ratio (INR), and etiology were predictors of rebleeding.
  
  
  CONCLUSIONS
  Thrombocytopenia is very common (>90% of patients) in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt) has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.
authors.affiliation: Department of Radiology, University of Virginia, Virginia, United States.
authors.forename: W E
authors.initials: WE
authors.lastname: Saad
authors.affiliation: Department of Internal Medicine, Owensboro Health Gastroenterology and Hepatology, Kentucky, United States.
authors.forename: W
authors.initials: W
authors.lastname: Bleibel
authors.affiliation: Department of Radiology, University of Virginia, Virginia, United States.
authors.forename: N
authors.initials: N
authors.lastname: Adenaw
authors.affiliation: Department of Surgery, University of Virginia, Virginia, United States.
authors.forename: C E
authors.initials: CE
authors.lastname: Wagner
authors.affiliation: Department of Radiology, University of Virginia, Virginia, United States.
authors.forename: C
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Department of Radiology, University of Virginia, Virginia, United States.
authors.forename: J F
authors.initials: JF
authors.lastname: Angle
authors.affiliation: Department of Medicine, University of Virginia, Virginia, United States.
authors.forename: A M
authors.initials: AM
authors.lastname: Al-Osaimi
authors.affiliation: Department of Surgery, Methodist Hospital, Cornell-Weiel School of Medicine, Houston, Texas, United States.
authors.forename: M G
authors.initials: MG
authors.lastname: Davies
authors.affiliation: Department of Medicine, University of Virginia, Virginia, United States.
authors.forename: S
authors.initials: S
authors.lastname: Caldwell
keywords: Balloon-occluded retrograde transvenous obliteration; balloon-occlusion; bleeding; gastric varices; platelet count