Current knowledge and management of portal vein thrombosis in cirrhosis.
Senzolo Marco,Garcia-Tsao Guadalupe,García-Pagán Juan Carlos
Journal of hepatology
Portal vein thrombosis (PVT) is an increasingly recognised complication of cirrhosis whose incidence increases in parallel with the severity of cirrhosis. Several risk factors have been associated with the occurrence and progression of PVT. Although the negative effect of complete PVT on the surgical outcome of liver transplant recipients is clear, its impact on cirrhosis progression remains uncertain. Treatment options include anticoagulants and interventional thrombolytic therapies, which are chosen almost on a case-by-case basis depending on the characteristics of the patient and the thrombus. In this manuscript, we review current knowledge regarding the epidemiology, risk factors, diagnosis and classification, natural history, clinical consequences and treatment of non-neoplastic PVT in cirrhosis.
Education level and chronic liver disease by aetiology: A proportional mortality study.
Fedeli Ugo,Avossa Francesco,Goldoni Carlo Alberto,Caranci Nicola,Zambon Francesco,Saugo Mario
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
BACKGROUND:Data are lacking on mortality from chronic liver diseases of different aetiology by education level. AIMS:To investigate the association between education level and mortality from alcoholic, viral, and non-viral/non-alcoholic chronic liver disease. METHODS:Proportional mortality was investigated in 2011-2013 in the Veneto Region (Italy). Odds ratios were estimated by conditional logistic regression with deaths from liver cirrhosis, liver cancer, and viral hepatitis as cases, and all other deaths as controls. Disease aetiology was determined from all conditions mentioned in the death certificate. RESULTS:Overall chronic liver disease proportional mortality was higher in males (OR 1.37, 95% CI 1.18-1.60) and females (OR 1.72, 95% CI 1.29-2.30) with primary education than in subjects with higher educational level. The risk for alcohol-related and non-viral/non-alcohol-related disease significantly increased with lower education in both genders. CONCLUSIONS:Proportional mortality analysis of multiple causes of death records showed an association between education and chronic liver diseases with alcoholic and non-viral/non-alcoholic aetiology.
Non-malignant portal vein thrombi in patients with cirrhosis consist of intimal fibrosis with or without a fibrin-rich thrombus.
Driever Ellen G,von Meijenfeldt Fien A,Adelmeijer Jelle,de Haas Robbert J,van den Heuvel Marius C,Nagasami Chandrasekaran,Weisel John W,Fondevila Constantino,Porte Robert J,Blasi Anabel,Heaton Nigel,Gregory Stephen,Kane Pauline,Bernal William,Zen Yoh,Lisman Ton
Hepatology (Baltimore, Md.)
BACKGROUND AND AIM:Portal vein thrombosis (PVT) is a common complication of cirrhosis. The exact pathophysiology remains largely unknown and treatment with anticoagulants does not lead to recanalization of the portal vein in all patients. A better insight in the structure and composition of portal vein thrombi may assist in developing new strategies for the prevention and treatment of PVT. METHODS:Sixteen prospectively and 63 retrospectively collected non-malignant portal vein thrombi from cirrhotic patients who underwent liver transplantation were included. Histology, immunohistochemistry and scanning electron microscopy were used to assess structure and composition of the thrombi. Most recent computed tomography (CT) scans were reanalysed for thrombus characteristics. Clinical characteristics were related to histological and radiological findings. RESULTS:All samples showed a thickened, fibrotic tunica intima. Fibrin-rich thrombi were present on top of the fibrotic intima in 9/16 prospective cases and in 21/63 retrospective cases. A minority of the fibrotic areas stained focally positive for fibrin/fibrinogen (fg, 16% of the cases), Von Willebrand Factor (VWF, 10%) and CD61 (platelets, 21%), while most of the fibrin-rich areas stained positive for those markers (fg, 100%; VWF, 77%; CD61, 100%). No associations were found between clinical characteristics including estimated thrombus age and use of anticoagulants and presence of fibrin-rich thrombi. CONCLUSION:Here we demonstrated that PVT in cirrhotic patients consists of intimal fibrosis with an additional fibrin-rich thrombus in only one-third of the cases. We hypothesize that our observations may explain why not all portal vein thrombi in cirrhotic patients recanalise by anticoagulant therapy.