Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry

Francesco Violi, Roberto Gino Corazza, Stephen Hugh Caldwell, Francesco Perticone, Angelo Gatta, Mario Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita Vestri, Valeria Raparelli, Stefania Basili, Palasciano Giuseppe, D'Alitto Felicia, Palmieri Vincenzo Ostilio, Santovito Daniela, Di Michele Dario, Croce Giuseppe, Sacerdoti David, Brocco SilviaFasolato Silvano, Cecchetto Lara, Bombonato Giancarlo, Bertoni Michele, Restuccia Tea, Andreozzi Paola, Liguori Maria Livia, Perticone Francesco, Caroleo Benedetto, Perticone Maria, Staltari Orietta, Manfredini Roberto, De Giorgi Alfredo, Averna Maurizio, Giammanco Antonina, Granito Alessandro, Pettinari Irene, Marinelli Sara, Bolondi Luigi, Falsetti Lorenzo, Salvi Aldo, Durante Mangoni Emanuele, Cesaro Flavio, Farinaro Vincenza, Ragone Enrico, Morana Ignazio, Andriulli Angelo, Ippolito Antonio, Iacobellis Angelo, Di Minno Giovanni, PRO-LIVER Collaborators

Research output: Contribution to journalArticle

39 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1059-1066
Number of pages8
JournalInternal and Emergency Medicine
Volume11
Issue number8
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Keywords

  • Anticoagulants
  • Esophageal varices
  • Hepatocellular carcinoma
  • Liver failure
  • Splanchnic venous thrombosis

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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    Violi, F., Corazza, R. G., Caldwell, S. H., Perticone, F., Gatta, A., Angelico, M., Farcomeni, A., Masotti, M., Napoleone, L., Vestri, A., Raparelli, V., Basili, S., Giuseppe, P., Felicia, DA., Ostilio, P. V., Daniela, S., Dario, D. M., Giuseppe, C., David, S., ... PRO-LIVER Collaborators (2016). Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry. Internal and Emergency Medicine, 11(8), 1059-1066. https://doi.org/10.1007/s11739-016-1416-8