Portal vein thrombosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Medical therapy for portal vein thrombosis include anticoagulation to maintain INR between 2 to 3. The goal of anticoagulation is to prevent extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop.
Medical Therapy
Pharmacologic therapy is recommended among patients with portal vein thrombosis without cirrhosis.[1][2][3]
- The following factors should be considered with treartment of portal vein thrombosis:[4][5][6]
- Correction of the causal factors
- Prevention of thrombosis extension
- Achievement of portal vein patency
- Management of complications related to portal hypertension
- Management of complications related to portal cholangiopathy[7]
- NOTE (1):Initiate anticougulation with heparin for 3-4 weeks then start oral vitamin K antagonist(e.g. warfarin) to maintain INR between 2 to 3.
- NOTE (2): Biliary abnormalities due to portal vein thrombosis are observed to be reversed after anti-coagulopathy therapy.
- NOTE (3): It is performed to initiate anticoagulation therapy early in course of disease.
Portal vein thrombosis
- 1. Portal vein thrombosis with cirrhosis
- NOTE: Chronic anticoagulation is generally not recommended
- 2. Portal vein thrombosis without cirrhosis
- 2.1 Chronic portal vein thrombosis
- 2.1.1 Chronic portal vein thrombosis with hypercoagulable state or previous history of vascular disease
- 2.1.1.1 Long term anticoaugulation
- Preferred regimen: Warfarin 2-5 mg PO q24h
- 2.1.1.2 Treatment of esophageal varices
- 2.1.1.1 Long term anticoaugulation
- 2.1.2. Chronic portal vein thrombosis without hypercoagulable state or previous history of vascular disease
- 2.1.1 Chronic portal vein thrombosis with hypercoagulable state or previous history of vascular disease
- NOTE: Chronic anticoagulation is generally not recommended
- 2.1.2.1 Treatment of esophageal varices
- 2.2 Acute portal vein thrombosis
- 2.1 Anticoagulant therapy
- 2.1.1 Acute portal vein thrombosis with hypercoagulable state
- Preferred regimen: Warfarin 2-5 mg PO q24h for long term
- 2.2.2 Acute portal vein thrombosis without hypercoagulable state
- Preferred regimen: Warfarin 2-5 mg PO q24h for 3-6 months
- 2.1.1 Acute portal vein thrombosis with hypercoagulable state
- 2.2 Thrombolytic therapy
- Preferred regimen: Recombinant tissue plasminogen activator (RTPA)[8]
- Alternate regimen(1): Urokinase[9]
- Alternate regimen(2): Streptokinase[9]
- NOTE: Administration of thrombolytic therapy in acute portal vein thrombosis[10][11][12]
- Indirect intraarterial infusion into the superior mesenteric artery
- Directly intoducing catheter into portal vein[13][14][8]
- Transhepatic
- Transjugular
- 2.1 Anticoagulant therapy
- 2.1 Chronic portal vein thrombosis
References
- ↑ Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010). "Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment". World J. Gastroenterol. 16 (2): 143–55. PMC 2806552. PMID 20066733.
- ↑ Parikh, Sameer; Shah, Riddhi; Kapoor, Prashant (2010). "Portal Vein Thrombosis". The American Journal of Medicine. 123 (2): 111–119. doi:10.1016/j.amjmed.2009.05.023. ISSN 0002-9343.
- ↑ Chawla YK, Bodh V (2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
- ↑ Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D (2001). "Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy". Gastroenterology. 120 (2): 490–7. PMID 11159889.
- ↑ Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR (2011). "Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review". World J Surg. 35 (11): 2510–20. doi:10.1007/s00268-011-1198-0. PMID 21882035.
- ↑ Amitrano L, Guardascione MA, Menchise A, Martino R, Scaglione M, Giovine S, Romano L, Balzano A (2010). "Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis". J. Clin. Gastroenterol. 44 (6): 448–51. doi:10.1097/MCG.0b013e3181b3ab44. PMID 19730112.
- ↑ DeLeve LD, Valla DC, Garcia-Tsao G (2009). "Vascular disorders of the liver". Hepatology. 49 (5): 1729–64. doi:10.1002/hep.22772. PMID 19399912.
- ↑ 8.0 8.1 Henao EA, Bohannon WT, Silva MB (2003). "Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator". J. Vasc. Surg. 38 (6): 1411–5. doi:10.1016/S0741. PMID 14681650.
- ↑ 9.0 9.1 Tateishi A, Mitsui H, Oki T, Morishita J, Maekawa H, Yahagi N, Maruyama T, Ichinose M, Ohnishi S, Shiratori Y, Minami M, Koutetsu S, Hori N, Watanabe T, Nagawa H, Omata M (2001). "Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation". J. Gastroenterol. Hepatol. 16 (12): 1429–33. PMID 11851847.
- ↑ Lopera JE, Correa G, Brazzini A, Ustunsoz B, Patel S, Janchai A, Castaneda-Zuniga W (2002). "Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis". J. Vasc. Surg. 36 (5): 1058–61. PMID 12422118.
- ↑ Aytekin C, Boyvat F, Kurt A, Yologlu Z, Coskun M (2001). "Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis". Eur J Radiol. 39 (2): 80–2. PMID 11522414.
- ↑ Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF (2005). "Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis". J Vasc Interv Radiol. 16 (5): 651–61. doi:10.1097/01.RVI.0000156265.79960.86. PMID 15872320.
- ↑ Schäfer C, Zundler J, Bode JC (2000). "Thrombolytic therapy in patients with portal vein thrombosis: case report and review of the literature". Eur J Gastroenterol Hepatol. 12 (10): 1141–5. PMID 11057461.
- ↑ Kercher KW, Sing RF, Watson KW, Matthews BD, LeQuire MH, Heniford BT (2002). "Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy". Surg Laparosc Endosc Percutan Tech. 12 (2): 131–6. PMID 11948303.