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TIPS benefits most cirrhotic patients with portal vein thrombosis

SAN DIEGO — Most patients with cirrhosis and portal vein thrombosis experienced either complete recanalization or marked improvement after placement of a transjugular portosystemic shunt in a study presented at the American College of Gastroenterology Annual Scientific Meeting.

In a single-center, retrospective cohort study, researchers evaluated 50 adult patients with cirrhosis who underwent transjugular portosystemic shunt (TIPS) between 2000 and 2010, with follow-up of 18 ± 6 months after the procedure. The cohort had a mean age of 55.3 ± 11 years at the time of TIPS. All participants had portal vein thrombosis (PVT) prior to receiving TIPS, and received serial Doppler vascular ultrasound every 3 months until death or liver transplantation. The most frequent indications for TIPS were refractory ascites (45% of cases) and variceal bleed (41%).

Upon undergoing TIPS, 68% of participants experienced complete portal vein recanalization, 20% indicated marked improvement (more than 50% patency in a previously thrombosed portal vein), and 12% experienced no improvement. Factors associated with complete recanalization included a short interval between the initial appearance of thrombosis and TIPS placement (HR=2.63, 1.17-7.5), less severe PVT (HR=3.13, 1.9-8.9) and the absence of ascites (HR=2.28, 1.5-10.2). Persistent PVT following the procedure was linked with esophageal variceal bleeding prior to TIPS (HR=1.9, 1.4-8.5) and the presence of alcoholic liver disease (HR=1.3, 1.1-6.2) (95% CI for all).

“This study has brought up new ideas in the field of PVT treatment,” researcher Modaresi Esfeh, MD, Cleveland Clinic, told Healio.com. “There are a lot of discrepancies in regard to PVT treatment. Unfortunately, there is no established management algorithm for PVT in cirrhotic patients. We showed that TIPS might be an answer to this unclear clinical entity.” Esfeh added that the investigators plan to continue to follow the study population in order to determine whether complete PVT resolution can improve survival or reduce the time to liver transplantation.

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Esfeh JM. #44: Effects of the Transjugular Intrahepatic Portosystemic Shunt on Portal Vein Thrombosis in Patients with Liver Cirrhosis. Presented at: The American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.