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.

Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry / 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.; Palasciano, G.; D'Alitto, F.; Palmieri, V. O.; Santovito, D.; Croce, G.; Sacerdoti, D.; Brocco, S.; Fasolato, S.; Cecchetto, L.; Bombonato, G.; Restuccia, R.; Andreozzi, P.; Liguori, L. M.; Perticone, M.; Staltari, O.; Manfredini, R.; De Giorgi, A.; Averna, M.; Giammanco, A.; Granito, A.; Marinelli, S.; Bolondi, L.; Falsetti, L.; Salvi, A.; Durante-Mangoni, E.; Cesaro, F.; Farinaro, V.; Ragone, E.; Morana, I.; Andriulli, A.; Ippolito, A.; Iacobellis, A.; Niro, G.; Merla, A.; Raimondo, G.; Maimone, S.; Cacciola, I.; Varvara, D.; Drenaggi, D.; Staffolani, S.; Picardi, A.; Vespasiani-Gentilucci, U.; Galati, G.; Gallo, P.; Davi, G.; Schiavone, C.; Santilli, F.; Tana, C.; Licata, A.; Soresi, M.; Bianchi, B. G.; Carderi, I.; Pinto, A.; Tuttolomondo, A.; Ferrari, G.; Gresele, P.; Fierro, T.; Morelli, O.; Laffi, G.; Romanelli, R. G.; Arena, U.; Cristina, S.; Gasbarrini, A.; Gargovich, M.; Zocco, Z. M.; Riccardi, L.; Ainora, M. E.; Capeci, W.; Martino, M. G.; Lorenzo, N.; Cavallo, M.; Frugiuele, P.; Greco, A.; Pietrangelo, A.; Ventura, P.; Cuoghi, C.; Marcacci, M.; Serviddio, G.; Vendemiale, G.; Villani, R.; Gargano, R.; Vidili, G.; Di Cesare, V.; Masala, M.; Delitala, G.; Invernizzi, P.; Di Minno, G.; Tufano, A.; Purrello, F.; Privitera, G.; Forgione, A.; Curigliano, V.; Senzolo, M.; Rodriguez-Castro, K. -I.; Giannelli, G.; Serra, C.; Neri, S.; Pignataro, P.; Rizzetto, M.; Debernardi, V. W.; Svegliati, B. G.; Bergamaschi, G.; Costanzo, F.; Angelico, F.; Del Ben, M.; Polimeni, L.; Talerico, G.; Proietti, M.; Romiti, G. F.; Ruscio, E.; Toriello, F.. - In: INTERNAL AND EMERGENCY MEDICINE. - ISSN 1828-0447. - 11:8(2016), pp. 1059-1066. [10.1007/s11739-016-1416-8]

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

Violi F.;Gatta A.;Masotti M.;Andreozzi P.;Averna M.;Giammanco A.;Marinelli S.;Salvi A.;Cesaro F.;Farinaro V.;Galati G.;Schiavone C.;Martino M. G.;Ventura P.;Serviddio G.;Gargano R.;Di Minno G.;Tufano A.;Purrello F.;Serra C.;Pignataro P.;Proietti M.;
2016

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.
2016
Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry / 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.; Palasciano, G.; D'Alitto, F.; Palmieri, V. O.; Santovito, D.; Croce, G.; Sacerdoti, D.; Brocco, S.; Fasolato, S.; Cecchetto, L.; Bombonato, G.; Restuccia, R.; Andreozzi, P.; Liguori, L. M.; Perticone, M.; Staltari, O.; Manfredini, R.; De Giorgi, A.; Averna, M.; Giammanco, A.; Granito, A.; Marinelli, S.; Bolondi, L.; Falsetti, L.; Salvi, A.; Durante-Mangoni, E.; Cesaro, F.; Farinaro, V.; Ragone, E.; Morana, I.; Andriulli, A.; Ippolito, A.; Iacobellis, A.; Niro, G.; Merla, A.; Raimondo, G.; Maimone, S.; Cacciola, I.; Varvara, D.; Drenaggi, D.; Staffolani, S.; Picardi, A.; Vespasiani-Gentilucci, U.; Galati, G.; Gallo, P.; Davi, G.; Schiavone, C.; Santilli, F.; Tana, C.; Licata, A.; Soresi, M.; Bianchi, B. G.; Carderi, I.; Pinto, A.; Tuttolomondo, A.; Ferrari, G.; Gresele, P.; Fierro, T.; Morelli, O.; Laffi, G.; Romanelli, R. G.; Arena, U.; Cristina, S.; Gasbarrini, A.; Gargovich, M.; Zocco, Z. M.; Riccardi, L.; Ainora, M. E.; Capeci, W.; Martino, M. G.; Lorenzo, N.; Cavallo, M.; Frugiuele, P.; Greco, A.; Pietrangelo, A.; Ventura, P.; Cuoghi, C.; Marcacci, M.; Serviddio, G.; Vendemiale, G.; Villani, R.; Gargano, R.; Vidili, G.; Di Cesare, V.; Masala, M.; Delitala, G.; Invernizzi, P.; Di Minno, G.; Tufano, A.; Purrello, F.; Privitera, G.; Forgione, A.; Curigliano, V.; Senzolo, M.; Rodriguez-Castro, K. -I.; Giannelli, G.; Serra, C.; Neri, S.; Pignataro, P.; Rizzetto, M.; Debernardi, V. W.; Svegliati, B. G.; Bergamaschi, G.; Costanzo, F.; Angelico, F.; Del Ben, M.; Polimeni, L.; Talerico, G.; Proietti, M.; Romiti, G. F.; Ruscio, E.; Toriello, F.. - In: INTERNAL AND EMERGENCY MEDICINE. - ISSN 1828-0447. - 11:8(2016), pp. 1059-1066. [10.1007/s11739-016-1416-8]
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