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A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis.
- Source :
-
European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2019 Jan; Vol. 31 (1), pp. 34-42. - Publication Year :
- 2019
-
Abstract
- Background and Objective: Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics.<br />Patients and Methods: Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled. All patients underwent evaluation of coagulation status and thrombophilia screening. Thrombus characteristics and extension were evaluated at baseline and during follow-up. Anticoagulation was continued until recanalization or up to 12 months. Variables correlated with the response to anticoagulation were used to create a predictive score that was validated in an external multicenter cohort.<br />Results: A total of 65 patients were included and had partial PVT in most cases (72%). Treatment with enoxaparin resulted in an overall response rate of 66% (43/65) after a median time of 4.4 months and 76% (33/43) within the first 6 months. At multivariate analysis, efficacy of anticoagulation correlated with the severity of liver disease, complete verus partial PVT, age of the thrombus, and time interval from treatment start (<6 months). The areas under the curve of the statistical model for predicting the response to anticoagulation were 0.84 and 0.76 for the training (n=65) and validation (n=60) cohorts, respectively.<br />Conclusion: Early diagnosis and early treatment are key factors for the successful management of PVT in cirrhosis, so that screening of PVT and prompt start of anticoagulant treatment should be mandatory.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anticoagulants adverse effects
Biomarkers blood
Blood Coagulation Tests
China
Early Diagnosis
Enoxaparin adverse effects
Female
Humans
Italy
Liver Cirrhosis blood
Liver Cirrhosis diagnosis
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Venous Thrombosis blood
Venous Thrombosis diagnostic imaging
Venous Thrombosis etiology
Anticoagulants therapeutic use
Blood Coagulation drug effects
Decision Support Techniques
Enoxaparin therapeutic use
Liver Cirrhosis complications
Portal Vein diagnostic imaging
Venous Thrombosis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5687
- Volume :
- 31
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- European journal of gastroenterology & hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 30188408
- Full Text :
- https://doi.org/10.1097/MEG.0000000000001237