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Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View

BACKGROUND: Treatment of non-malignant portal vein thrombosis (PVT) in patients with cirrhosis has been neglected in the past because of the fear of bleeding complications when using anticoagulation and due to the technical difficulties associated with the implantation of the transjugular intrahepat...

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Autores principales: Rössle, Martin, Bausch, Birke, Klinger, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger Verlag für Medizin und Naturwissenschaften GmbH 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513837/
https://www.ncbi.nlm.nih.gov/pubmed/26288607
http://dx.doi.org/10.1159/000370053
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author Rössle, Martin
Bausch, Birke
Klinger, Christoph
author_facet Rössle, Martin
Bausch, Birke
Klinger, Christoph
author_sort Rössle, Martin
collection PubMed
description BACKGROUND: Treatment of non-malignant portal vein thrombosis (PVT) in patients with cirrhosis has been neglected in the past because of the fear of bleeding complications when using anticoagulation and due to the technical difficulties associated with the implantation of the transjugular intrahepatic portosystemic shunt (TIPS). However, PVT has a negative impact on outcome and compromises liver transplantation, warranting treatment by using anticoagulation and TIPS. METHODS: This review considers studies on the treatment of PVT in cirrhosis published in the last 10 years. Unfortunately, many of these studies are limited by their retrospective design and a small sample size. RESULTS: Anticoagulation using low-molecular-weight heparin (LMWH) or vitamin K antagonists is effective in the treatment of patients with limited and recent PVT, resulting in a recanalization in up to 50% of the patients. TIPS (plus local measures) results in a recanalization of up to 100% and reduces the rebleeding rate considerably in patients with recent or chronic PVT. CONCLUSION: Based on the presently limited knowledge, a therapy algorithm is suggested favouring the TIPS as a first-line treatment for PVT in patients with symptomatic portal hypertension. Patients with thus far asymptomatic portal hypertension may first receive anticoagulation, preferably using LMWH. If these patients have a condition where anticoagulation is not promising (complete, extended, chronic PVT) or ineffective, or if they are candidates for liver transplantation, the TIPS may be implanted without delay.
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spelling pubmed-45138372015-12-01 Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View Rössle, Martin Bausch, Birke Klinger, Christoph Viszeralmedizin Review Article • Übersichtsarbeit BACKGROUND: Treatment of non-malignant portal vein thrombosis (PVT) in patients with cirrhosis has been neglected in the past because of the fear of bleeding complications when using anticoagulation and due to the technical difficulties associated with the implantation of the transjugular intrahepatic portosystemic shunt (TIPS). However, PVT has a negative impact on outcome and compromises liver transplantation, warranting treatment by using anticoagulation and TIPS. METHODS: This review considers studies on the treatment of PVT in cirrhosis published in the last 10 years. Unfortunately, many of these studies are limited by their retrospective design and a small sample size. RESULTS: Anticoagulation using low-molecular-weight heparin (LMWH) or vitamin K antagonists is effective in the treatment of patients with limited and recent PVT, resulting in a recanalization in up to 50% of the patients. TIPS (plus local measures) results in a recanalization of up to 100% and reduces the rebleeding rate considerably in patients with recent or chronic PVT. CONCLUSION: Based on the presently limited knowledge, a therapy algorithm is suggested favouring the TIPS as a first-line treatment for PVT in patients with symptomatic portal hypertension. Patients with thus far asymptomatic portal hypertension may first receive anticoagulation, preferably using LMWH. If these patients have a condition where anticoagulation is not promising (complete, extended, chronic PVT) or ineffective, or if they are candidates for liver transplantation, the TIPS may be implanted without delay. S. Karger Verlag für Medizin und Naturwissenschaften GmbH 2014-12 2014-12-04 /pmc/articles/PMC4513837/ /pubmed/26288607 http://dx.doi.org/10.1159/000370053 Text en Copyright © 2014 by S. Karger GmbH, Freiburg
spellingShingle Review Article • Übersichtsarbeit
Rössle, Martin
Bausch, Birke
Klinger, Christoph
Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title_full Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title_fullStr Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title_full_unstemmed Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title_short Therapy Algorithm for Portal Vein Thrombosis in Liver Cirrhosis: The Internist's Point of View
title_sort therapy algorithm for portal vein thrombosis in liver cirrhosis: the internist's point of view
topic Review Article • Übersichtsarbeit
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513837/
https://www.ncbi.nlm.nih.gov/pubmed/26288607
http://dx.doi.org/10.1159/000370053
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