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Anticoagulant therapy in patients with non-cirrhotic portal vein thrombosis: effect on new thrombotic events and gastrointestinal bleeding.
J Thromb Haemost. 2013 Jan 5;
Authors: Spaander MC, Hoekstra J, Hansen BE, van Buuren HR, Leebeek FW, Janssen HL
Abstract
BACKGROUND & AIMS: It remains unclear when anticoagulant therapy should be given in patients with non-cirrhotic portal vein thrombosis (PVT). Aim of this study was to assess the effect of anticoagulation on recurrent thrombotic events and gastrointestinal bleeding in non-cirrhotic PVT patients. METHODS: Retrospective study of all patients with non-cirrhotic PVT (n=120), seen at our hospital from 1985 to 2009. Data were collected by systematic chart review. RESULTS: Sixty-six of the 120 patients were treated with anticoagulants. Twenty-two recurrent thrombotic events occurred in 19 patients. Overall thrombotic risk at one, five and ten years was 4%, 8% and 27%, respectively. Seventy-four percent of all recurrent thrombotic events occurred in patients with a prothrombotic disorder. Anticoagulant therapy tended to lower the risk of recurrent thrombosis (HR 0.2 p=0.1), yet the only significant predictor of recurrent thrombotic events was presence of a prothrombotic disorder (HR 3.1 p=0.03). In thirty-seven patients 83 gastrointestinal bleeding events occurred. Rebleeding risk at one, five and ten years was 19%, 46% and 49%, respectively. Anticoagulation therapy (HR 2.0 p=<0.01) was a significant predictors of (re)bleeding. Anticoagulation therapy had no effect on severity of gastrointestinal bleeding. Poor survival was associated with recurrent thrombotic events (HR 3.1 p=0.02), whereas bleeding (HR 1.6 p=0.2) and anticoagulant treatment (HR 0.5 p=0.2) had no significant effect on survival. CONCLUSIONS: In non-cirrhotic PVT patients recurrent thrombotic events are mainly observed in patients with underlying prothrombotic disorders. Anticoagulation therapy tends to prevent recurrent thrombosis but also significantly increases the risk of gastrointestinal bleeding. © 2013 International Society on Thrombosis and Haemostasis.
PMID: 23289370 [PubMed - as supplied by publisher]