Alimentary Pharmacology and Therapeutics
Letters to the Editors Letter: management of portal vein thromboses in cirrhosis A. Mancuso*,† *Medicina Interna 1, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy. † Epatologia e Gastroenterologia, Ospedale Niguarda Ca Granda, Milan, Italy. E-mail: [email protected]
In conclusion, at the present time, management of PVT in cirrhosis should be personalised. In particular, anti-coagulation and TIPSS is probably indicated in cases suitable for liver transplant (LT), mostly to prevent PVT extension, but otherwise avoided in those not suitable for LT and with an otherwise poor prognosis.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None.
doi:10.1111/apt.13103
REFERENCES SIRS, I read with interest the review article on portal vein obstruction.1 However, I feel that some more of the discussion should have been spent on the management of portal vein thromboses (PVT) in cirrhosis. In fact, although treatment for acute PVT is generally indicated,2 since PVT is often asymptomatic, it is often not obvious when the PVT occurred. Moreover, although anti-coagulation with different regimens has been reported to be effective, the real risk/benefit ratio of such treatment has not been fully explored.2–4 Furthermore, differently from what was described in the present review,1 which patients to treat and how long treatment should last are grey areas and physician choices may be empirical. Another possibility of treatment of PVT in cirrhosis is TIPSS,5 which is probably able to cure PVT by increasing portal vein flow velocity, so potentially avoiding the need for anti-coagulation after TIPSS and the increased risk of bleeding. Moreover, as described in Budd Chiari syndrome,6–8 TIPSS could potentially ameliorate the degree of hepatic dysfunction due to ischaemia,9 in patients with adequate hepatic functional reserve.10
1. Kumar A, Sharma P, Arora A. Review article: portal vein obstruction – epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther 2015; 41: 276–92. 2. DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology 2009; 49: 1729–64. 3. Chawla Y, Duseja A, Dhiman RK. Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 2009; 30: 881–94. 4. Turnes J, Garcıa-Pagan JC, Gonzalez M, et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6: 1412–7. 5. Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut 2011; 60: 846–52. 6. Mancuso A. Budd-Chiari syndrome management: lights and shadows. World J Hepatol 2011; 3: 262–4. 7. Mancuso A. An update on management of Budd-Chiari syndrome. Ann Hepatol 2014; 3: 323–6. 8. Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment. Eur J Gastro Hepatol 2015; (in press). 9. Mancuso A. Cirrhosis development probably arises from chronic micro-vascular ischemia. Med Hypotheses 2014; 82: 243–4. 10. Mancuso A. Budd-Chiari Syndrome management: timing of treatment is an open issue. Hepatology 2014; 59: 1213.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 300 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
698
ª 2015 John Wiley & Sons Ltd
Letters to the Editors Letter: management of portal vein thromboses in cirrhosis A. Mancuso*,† *Medicina Interna 1, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy. † Epatologia e Gastroenterologia, Ospedale Niguarda Ca Granda, Milan, Italy. E-mail: [email protected]
In conclusion, at the present time, management of PVT in cirrhosis should be personalised. In particular, anti-coagulation and TIPSS is probably indicated in cases suitable for liver transplant (LT), mostly to prevent PVT extension, but otherwise avoided in those not suitable for LT and with an otherwise poor prognosis.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None.
doi:10.1111/apt.13103
REFERENCES SIRS, I read with interest the review article on portal vein obstruction.1 However, I feel that some more of the discussion should have been spent on the management of portal vein thromboses (PVT) in cirrhosis. In fact, although treatment for acute PVT is generally indicated,2 since PVT is often asymptomatic, it is often not obvious when the PVT occurred. Moreover, although anti-coagulation with different regimens has been reported to be effective, the real risk/benefit ratio of such treatment has not been fully explored.2–4 Furthermore, differently from what was described in the present review,1 which patients to treat and how long treatment should last are grey areas and physician choices may be empirical. Another possibility of treatment of PVT in cirrhosis is TIPSS,5 which is probably able to cure PVT by increasing portal vein flow velocity, so potentially avoiding the need for anti-coagulation after TIPSS and the increased risk of bleeding. Moreover, as described in Budd Chiari syndrome,6–8 TIPSS could potentially ameliorate the degree of hepatic dysfunction due to ischaemia,9 in patients with adequate hepatic functional reserve.10
1. Kumar A, Sharma P, Arora A. Review article: portal vein obstruction – epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther 2015; 41: 276–92. 2. DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology 2009; 49: 1729–64. 3. Chawla Y, Duseja A, Dhiman RK. Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 2009; 30: 881–94. 4. Turnes J, Garcıa-Pagan JC, Gonzalez M, et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6: 1412–7. 5. Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut 2011; 60: 846–52. 6. Mancuso A. Budd-Chiari syndrome management: lights and shadows. World J Hepatol 2011; 3: 262–4. 7. Mancuso A. An update on management of Budd-Chiari syndrome. Ann Hepatol 2014; 3: 323–6. 8. Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment. Eur J Gastro Hepatol 2015; (in press). 9. Mancuso A. Cirrhosis development probably arises from chronic micro-vascular ischemia. Med Hypotheses 2014; 82: 243–4. 10. Mancuso A. Budd-Chiari Syndrome management: timing of treatment is an open issue. Hepatology 2014; 59: 1213.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 300 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
698
ª 2015 John Wiley & Sons Ltd
