Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
PORTAL VEIN THROMBOSIS IN CIRRHOTIC PATIENTS: SAFETY AND EFFICACY OF LOW DOSAGE OF ENOXAPARIN
A.M. Pellicelli1*, P. Guarascio1, C. D'Ambrosio1, A.E. Lusi1, R. Villani1, L. Fondacaro1, G. Cerasari1, G. Liotta2, G. Vennarecci2, R. Santoro2, G.M. Ettorre2, A. Andreoli1
1Liver Unit, Azienda Ospedaliera San Camillo Forlanini, 2Surgical Oncology and Liver Transplantation Unit, POIT San Camillo Forlanini-Spallanzani, Rome, Italy. *email@example.com
Aim: Portal Vein Thrombosis (PVT) is a well known risk of liver cirrhosis (LC) despite the longer coagulation times. Patients with advanced liver disease have an increase risk of bleeding because of coagulopathy and portal hypertension. The aim of our study was to assess the efficacy and safety of low dosage of enoxaparin in patients with advanced LC and with PVT.´
Methods: From August 2008 to August 2009 we screened for hepatocellular carcinoma 155 cirrhotic patients by ultrasound Doppler. Fifteen patients presented PVT without hepatocellular carcinoma. Six patients with portal cavernoma were excluded from the study. Only nine patients with recent PVT entered the study and, after informed consent, received 100U/kg/day of enoxaparin subcutaneously for at least four months. An endoscopic examination and Computed Tomography (CT) was performed in all the patients. A Follow up by ultrasound with Doppler examination was done every month while CT was done at fourth month.
Results: The etiology of cirrhosis was: HCV infection in five patients, alcoholic in two, HBV+HDV in one and HBV in one. Six patients were in class A Child Pugh and three in class B. Seven patients presented class F1/F2 esophageal varices, while two patients with F3 class and the evidence of red cherry spot were previous submitted to band ligation. PVT was occludent in two patients (Figure 1) and incomplete in seven patient. Extension to portal branches was noted in three patients while extension to splenic and superior mesenteric vein was disclosed respectively in two and one patients. Complete recanalization of PVT occurred in three patients (33%) (one of whom with a total PVT), while partial recanalization was seen in six patients (67%). No significant side effects were noted in all the patients. All the data are reported in the Table.
|CASE ||AGE ||GENDER ||SITE OF THROMBOSIS ||REGRESSION OF THROMBOSIS ||DURATION TIME OF TREATMENT (months) |
|1 ||66 ||M ||portal trunk+portal branches (incomplete thrombosis) ||Total ||3 |
|2 ||51 ||M ||portal trunk+portal branches (incomplete thrombosis) ||Total ||4 |
|3 ||63 ||F ||portal trunk+portal branches (complete thrombosis) ||Partial ||4 |
|4 ||70 ||F ||portal trunk+portal branches (complete thrombosis) ||Partial ||3 |
|5 ||59 ||M ||portal trunk (incomplete thrombosis) ||Total ||3 |
|6 ||62 ||F ||portal trunk+portal branches+Splenic vein+Sup.m.vein (incomplete thrombosis) ||Partial ||3 |
|7 ||72 ||M ||portal trunk+portal branches+Splenic vein (incomplete thrombosis) ||Partial ||3 |
|8 ||48 ||F ||portal trunk+portal branches (incomplete thrombosis) ||Partial ||3 |
|9 ||68 ||M ||portal trunk+portal branches (incomplete thrombosis) ||Partial ||3 |
Conclusion: In cirrhotic patients with PVT anti-thromboembolic therapy with low dosage of enoxaparin (100UI/Kg/day) seems to be safe and effective as treatment with standard dosage (200UI/Kg/day).