Portal vein thrombosis medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{Portal vein thrombosis}}
{{Portal vein thrombosis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{F.K}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
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.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
Pharmacologic therapy is recommended among patients with portal vein thrombosis without [[cirrhosis]].<ref name="pmid20066733">{{cite journal |vauthors=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 |title=Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment |journal=World J. Gastroenterol. |volume=16 |issue=2 |pages=143–55 |year=2010 |pmid=20066733 |pmc=2806552 |doi= |url=}}</ref><ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref><ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |year=2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*The following factors should be considered with treartment of portal vein thrombosis:<ref name="pmid11159889">{{cite journal |vauthors=Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D |title=Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy |journal=Gastroenterology |volume=120 |issue=2 |pages=490–7 |year=2001 |pmid=11159889 |doi= |url=}}</ref><ref name="pmid21882035">{{cite journal |vauthors=Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR |title=Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review |journal=World J Surg |volume=35 |issue=11 |pages=2510–20 |year=2011 |pmid=21882035 |doi=10.1007/s00268-011-1198-0 |url=}}</ref><ref name="pmid19730112">{{cite journal |vauthors=Amitrano L, Guardascione MA, Menchise A, Martino R, Scaglione M, Giovine S, Romano L, Balzano A |title=Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis |journal=J. Clin. Gastroenterol. |volume=44 |issue=6 |pages=448–51 |year=2010 |pmid=19730112 |doi=10.1097/MCG.0b013e3181b3ab44 |url=}}</ref>
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
**Correction of the causal factors
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
**Prevention of thrombosis extension
===Disease Name===
**Achievement of portal vein patency
**Management of complications related to [[portal hypertension]]
**Management of complications related to portal cholangiopathy<ref name="pmid19399912">{{cite journal |vauthors=DeLeve LD, Valla DC, Garcia-Tsao G |title=Vascular disorders of the liver |journal=Hepatology |volume=49 |issue=5 |pages=1729–64 |year=2009 |pmid=19399912 |doi=10.1002/hep.22772 |url=}}</ref>
*:'''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.
*:*Improves recanalization rates
*:*Minimizes serious complication like peritonitis due to bowel necrosis
*:*Decrease development of esophageal [[varices]] and complications associated with [[varices]]
===Portal vein thrombosis===


* '''1. Portal vein thrombosis with cirrhosis'''
* '''1. Portal vein thrombosis with cirrhosis'''
**'''NOTE:''' Chronic anticoagulation is generally not recommended
**'''NOTE:''' Chronic [[anticoagulation]] is generally not recommended


*'''2. Portal vein thrombosis without cirrhosis'''
*'''2. Portal vein thrombosis without cirrhosis'''
**'''2.1 Chronic portal vein thrombosis'''
**'''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 Chronic portal vein thrombosis with [[hypercoagulable state]] or previous history of [[vascular disease]]
****2.1.1.1 Long term anticoaugulation
****2.1.1.1 Long term anticoaugulation
*****Preferred regimen: Warfarin 2-5 mg PO q24h
*****Preferred regimen: Warfarin 2-5 mg PO q24h
****2.1.1.2 [[Gastrointestinal varices medical therapy#Treatment of Esophageal Varices|Treatment of esophageal varices]]
****2.1.1.2 [[Esophageal varices #Treatment|Treatment of esophageal varices]]
***2.1.2. Chronic portal vein thrombosis without hypercoagulable state or previous history of vascular disease
***2.1.2. Chronic portal vein thrombosis without [[hypercoagulable state]] or previous history of [[vascular disease]]
**'''NOTE:''' Chronic anticoagulation is generally not recommended
**'''NOTE:''' Chronic anticoagulation is generally not recommended
***2.1.2.1 [[Gastrointestinal varices medical therapy#Treatment of Esophageal Varices|Treatment of esophageal varices]]
***2.1.2.1 [[Esophageal varices #Treatment|Treatment of esophageal varices]]
 
**'''2.2 Acute portal vein thrombosis'''
*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
***2.2 Thrombolytic therapy
***:* Preferred regimen: [[recombinant tissue plasminogen activator|Recombinant tissue plasminogen activator (RTPA)]]<ref name="pmid14681650">{{cite journal |vauthors=Henao EA, Bohannon WT, Silva MB |title=Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator |journal=J. Vasc. Surg. |volume=38 |issue=6 |pages=1411–5 |year=2003 |pmid=14681650 |doi=10.1016/S0741 |url=}}</ref>
***:*Alternate regimen(1): [[Urokinase]]<ref name="pmid11851847">{{cite journal |vauthors=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 |title=Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1429–33 |year=2001 |pmid=11851847 |doi= |url=}}</ref>
***:*Alternate regimen(2): [[Streptokinase]]<ref name="pmid11851847">{{cite journal |vauthors=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 |title=Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1429–33 |year=2001 |pmid=11851847 |doi= |url=}}</ref>
**: '''NOTE:''' Administration of [[thrombolytic therapy]] in acute portal vein thrombosis<ref name="pmid12422118">{{cite journal |vauthors=Lopera JE, Correa G, Brazzini A, Ustunsoz B, Patel S, Janchai A, Castaneda-Zuniga W |title=Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis |journal=J. Vasc. Surg. |volume=36 |issue=5 |pages=1058–61 |year=2002 |pmid=12422118 |doi= |url=}}</ref><ref name="pmid11522414">{{cite journal |vauthors=Aytekin C, Boyvat F, Kurt A, Yologlu Z, Coskun M |title=Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis |journal=Eur J Radiol |volume=39 |issue=2 |pages=80–2 |year=2001 |pmid=11522414 |doi= |url=}}</ref><ref name="pmid15872320">{{cite journal |vauthors=Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF |title=Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis |journal=J Vasc Interv Radiol |volume=16 |issue=5 |pages=651–61 |year=2005 |pmid=15872320 |doi=10.1097/01.RVI.0000156265.79960.86 |url=}}</ref>
**:*Indirect intraarterial infusion into the [[superior mesenteric artery]]
**:*Directly intoducing catheter into portal vein<ref name="pmid11057461">{{cite journal |vauthors=Schäfer C, Zundler J, Bode JC |title=Thrombolytic therapy in patients with portal vein thrombosis: case report and review of the literature |journal=Eur J Gastroenterol Hepatol |volume=12 |issue=10 |pages=1141–5 |year=2000 |pmid=11057461 |doi= |url=}}</ref><ref name="pmid11948303">{{cite journal |vauthors=Kercher KW, Sing RF, Watson KW, Matthews BD, LeQuire MH, Heniford BT |title=Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy |journal=Surg Laparosc Endosc Percutan Tech |volume=12 |issue=2 |pages=131–6 |year=2002 |pmid=11948303 |doi= |url=}}</ref><ref name="pmid14681650">{{cite journal |vauthors=Henao EA, Bohannon WT, Silva MB |title=Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator |journal=J. Vasc. Surg. |volume=38 |issue=6 |pages=1411–5 |year=2003 |pmid=14681650 |doi=10.1016/S0741 |url=}}</ref>
**:**Transhepatic
**:**Transjugular


==References==
==References==

Latest revision as of 14:43, 29 December 2017

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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.
    • Improves recanalization rates
    • Minimizes serious complication like peritonitis due to bowel necrosis
    • Decrease development of esophageal varices and complications associated with varices

Portal vein thrombosis

  • 1. Portal vein thrombosis with cirrhosis

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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. ↑ 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. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.

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