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EnglishPortal 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.
| Data di pubblicazione: | 2016 | |
| Titolo: | Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry | |
| Autori: | Francesco, Violi; Roberto, Corazza Gino; Hugh, Caldwell Stephen; Francesco, Perticone; Angelo, Gatta; Mario, Angelico; Alessio, Farcomeni; Michela, Masotti; Laura, Napoleone; Annarita, Vestri; Raparelli, Valeria; Stefania, Basili; Giuseppe, Palasciano; Felicia, D’Alitto; Ostilio, Palmieri Vincenzo; Daniela, Santovito; Dario, Di Michele; Giuseppe, Croce; David, Sacerdoti; Silvia, Brocco; Silvano, Fasolato; Lara, Cecchetto; Giancarlo, Bombonato; Michele, Bertoni; Tea, Restuccia; Paola, Andreozzi; Livia, Liguori Maria; Benedetto, Caroleo; Maria, Perticone; Orietta, Staltari; Manfredini, Roberto; Alfredo, De Giorgi; Maurizio, Averna; Antonina, Giammanco; Alessandro, Granito; Irene, Pettinari; Sara, Marinelli; Luigi, Bolondi; Lorenzo, Falsetti; Aldo, Salvi; Emanuele, Durante Mangoni; Flavio, Cesaro; Vincenza, Farinaro; Enrico, Ragone; Ignazio, Morana; Angelo, Andriulli; Antonio, Ippolito; Angelo, Iacobellis; Grazia, Niro; Antonio, Merla; Giovanni, Raimondo; Sergio, Maimone; Irene, Cacciola; Doriana, Varvara; Davide, Drenaggi; Silvia, Staffolani; Antonio, Picardi; Umberto, Vespasiani Gentilucci; Giovanni, Galati; Paolo, Gallo; Giovanni, Davì; Cosima, Schiavone; Francesca, Santilli; Claudio, Tana; Anna, Licata; Maurizio, Soresi; Battista, Bianchi Giovanni; Isabella, Carderi; Antonio, Pinto; Antonino, Tuttolomondo; Giovanni, Ferrari; Paolo, Gresele; Tiziana, Fierro; Olivia, Morelli; Giacomo, Laffi; Giulio, Romanelli Roberto; Umberto, Arena; Cristina, Stasi; Antonio, Gasbarrini; Matteo, Gargovich; Assunta, Zocco Maria; Laura, Riccardi; Elena, Ainora Maria; William, Capeci; Pio, Martino Giuseppe; Lorenzo, Nobili; Maurizio, Cavallo; Pierluigi, Frugiuele; Antonio, Greco; Antonello, Pietrangelo; Paolo, Ventura; Chiara, Cuoghi; Matteo, Marcacci; Gaetano, Serviddio; Gianluigi, Vendemiale; Rosanna, Villani; Ruggiero, Gargano; Gianpaolo, Vidili; Valentina, Di Cesare; Maristella, Masala; Giuseppe, Delitala; Pietro, Invernizzi; Giovanni, Di Minno; Antonella, Tufano; Francesco, Purrello; Graziella, Privitera; Alessandra, Forgione; Valentina, Curigliano; Marco, Senzolo; Isabel, Rodríguez Castro Kryssia; Gianluigi, Giannelli; Carla, Serra; Sergio, Neri; Pietro, Pignataro; Mario, Rizzetto; Wilma, Debernardi Venon; Gianluca, Svegliati Baroni; Gaetano, Bergamaschi; Michela, Masotti; Filippo, Costanzo; Francesco, Angelico; Maria, Del Ben; Laura, Napoleone; Licia, Polimeni; Valeria, Raparelli; Giovanni, Talerico; Marco, Proietti; Francesco, Romiti Giulio; Eleonora, Ruscio; Filippo, Toriello . | |
| Rivista: | INTERNAL AND EMERGENCY MEDICINE | |
| Keywords: | Anticoagulants; Esophageal varices; Hepatocellular carcinoma; Liver failure; Splanchnic venous thrombosis; | |
| Abstract in inglese: | 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. | |
| Digital Object Identifier (DOI): | 10.1007/s11739-016-1416-8 | |
| Handle: | http://hdl.handle.net/11392/2356188 | |
| Appare nelle tipologie: | 03.1 Articolo su rivista |
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