The implications and risk factor analysis of portal vein thrombosis in esophageal and gastric variceal bleeding in cirrhotic patients

Abstract

Abstract: Objective To investigate the significance of portal vein thrombosis (PVT) in patients with cirrhosis experiencing esophageal and gastric variceal bleeding (EGVB) as well as the safety of anticoagulation therapy. Additionally, it analyzes the risk factors associated with the occurrence of EGVB in this patient group.Methods Patients with cirrhosis treated at our hospital from January 2012 to December 2022 were enrolled and followed clinically for one year to ascertain the incidence of EGVB. The color Doppler ultrasonography and enhanced CT of the upper abdomen were applied to diagnose PVT. Cox proportional hazards regression and Kaplan-Meier analysis were utilized to identify independent risk factors related to EGVB.Results Out of 518 patients followed for one year, 167 were diagnosed with PVT. Compared with patients without PVT, those with PVT exhibited a significantly higher proportion of severe variceal patients (91.0% vs 82.1%) (P<0.05). Cox regression analysis of all cirrhotic patients confirmed that portal vein thrombosis (HR: 1.482, 95% CI: 1.051-2.090), Child-Pugh score (HR: 1.446, 95% CI: 1.270-1.645), AST levels (HR: 1.010, 95% CI: 1.006-1.014), and international normalized ratio (INR) (HR: 0.341, 95% CI: 0.155-0.751) were independently associated with the risk of EGVB within one year (all P<0.05). Cox regression analysis of patients with cirrhosis and PVT found that chronic PVT (HR: 4.089, 95% CI: 2.247-7.441), elevated Child-Pugh score (HR: 1.787, 95% CI: 1.335-2.392), and increased AST levels (HR: 1.008, 95% CI: 1.003-1.013) significantly correlated with the occurrence of EGVB within one year (all P<0.05). However, there was no significant association with the location of PVT and anticoagulation therapy (all P>0.05).Conclusion PVT increases the risk of EGVB in patients with cirrhosis. Among those with cirrhosis and PVT, EGVB occurrence is unrelated to anticoagulation therapy but significantly associated with chronic PVT, Child-Pugh score, and AST levels.

Key words: Cirrhosis, Esophageal and gastric variceal bleeding, Portal vein thrombosis, Prognostic analysis

LUO Zuan. The implications and risk factor analysis of portal vein thrombosis in esophageal and gastric variceal bleeding in cirrhotic patients[J]. Chinese Hepatolgy, 2024, 29(12): 1512-1516.

References

[1] Giuli L, Pallozzi M, Venturini G, et al. Molecular Mechanisms Underlying Vascular Liver Diseases: Focus on Thrombosis[J]. Int J Mol Sci,2023,24(16):12754.
[2] Zhang Y, Xu BY, Wang XB, et al. Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation[J]. Clin Gastroenterol Hepatol,2020,18(11):2564-2572.e1.
[3] Gao Z, Zhao J, Liu X, et al. Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case-control study[J]. Hepatol Int,2021,15(5):1183-1195.
[4] Intagliata NM, Argo CK, Stine JG, et al. Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference[J]. Thromb Haemost,2018,118(8):1491-1506.
[5] Senzolo M, Garcia-Tsao G, García-Pagán JC. Current knowledge and management of portal vein thrombosis in cirrhosis[J]. J Hepatol,2021,75(2):442-453.
[6] Yang L, Sun R, Wei N, et al. Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding[J]. Ann Med,2021,53(1):1806-1815.
[7] Tantai XX, Liu N, Yang LB, et al. Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding[J]. World J Gastroenterol,2019,25(45):6668-6680.
[8] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志,2019,27(11):846-865.
[9] O'Leary JG, Greenberg CS, Patton HM, et al. AGA Clinical Practice Update: Coagulation in Cirrhosis[J]. Gastroenterology,2019,157(1):34-43.e1.
[10] Pettinari I, Vukotic R, Stefanescu H, et al. Clinical Impact and Safety of Anticoagulants for Portal Vein Thrombosis in Cirrhosis[J]. Am J Gastroenterol,2019,114(2):258-266.
[11] Loffredo L, Pastori D, Farcomeni A, et al. Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-analysis[J]. Gastroenterology,2017,153(2):480-487.e1.
[12] Bosch J, Chung C, Carrasco-Zevallos OM, et al. A Machine Learning Approach to Liver Histological Evaluation Predicts Clinically Significant Portal Hypertension in NASH Cirrhosis[J]. Hepatology,2021,74(6):3146-3160.
[13] Bass LM, Ye W, Hawthorne K, et al. Risk of variceal hemorrhage and pretransplant mortality in children with biliary atresia[J]. Hepatology,2022,76(3):712-726.
[14] Prakash S, Bies J, Hassan M, et al. Portal vein thrombosis in cirrhosis: A literature review[J]. Front Med (Lausanne). 2023,10:1134801.
[15] Abraldes JG, Caraceni P, Ghabril M, et al. Update in the Treatment of the Complications of Cirrhosis[J]. Clin Gastroenterol Hepatol,2023,21(8):2100-2109.