title: Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry.
abstract: Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the "Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry" (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child-Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected portal vein thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the portal vein thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p < 0.001), Child-Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with portal vein thrombosis. Portal vein thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate-severe liver failure. The apparent undertreatment of patients with portal vein thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.violi@uniroma1.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.affiliation: First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
authors.affiliation: Division of Gastroenterology and Hepatology, Digestive Health Center, University of Virginia, Charlottesville, VA, USA.
authors.forename: Stephen Hugh
authors.initials: SH
authors.lastname: Caldwell
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
authors.affiliation: Department of Medicine, University of Padova, Padua, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.affiliation: Liver Unit, University Hospital Tor Vergata, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.affiliation: Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Masotti
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Napoleone
authors.affiliation: Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Raparelli
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000503:physiopathology*; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*
keywords: Anticoagulants; Esophageal varices; Hepatocellular carcinoma; Liver failure; Splanchnic venous thrombosis