PORTAL VEIN THROMBOSIS: DIAGNOSTIC DIFFICULTIES (CASE REPORT)
Abstract
Portal vein thrombosis (PVT) results from local factors (abdominal inflammatory diseases, vein injuries) as well as systemic ones (hereditary and acquired thrombophilia). In some cases, the diagnostics of PVT is associated with some difficulties. The necessary duration of anticoagulation therapy hasn't been fully established yet. The article presents a case of clinical follow-up of the patient being treated in the hematology department for chronic myeloproliferative disease, aggravated by the development of PVT. This case shows that specific therapy, including anticoagulation therapy and administration of cytostatic drugs is the most important part of the management and significantly reduces the risk of thrombosis recurrence. The use of complex etiopathogenetic approach to the treatment of PVT aggravated by thrombophilia significantly improves the outcome.References
1. de Franchis R, Baveno VF. Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. Journal of Hepatology. 2010;53(4):762-768. doi: 10.1016/j.jhep.2010.06.004.
2. Gaiani S, Bolondi L, Li BS, Zironi G, Siringo S, Barbara L. Prevalence of spontaneous hepatofugal portal flow in liver cirrhosis. Clinical and endoscopic correlation in 228 patients. Gastroenterology. 1991;100(1):160-167.
3. Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, Grandone E, Balzano A. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. Journal of Hepatology. 2006;40(5):736-741. doi: 10.1016/j.jhep.2004.01.001.
4. Primignani M, Martinelli I, Bucciarelli P, Battaglioli T, Reati R, Fabris F, Dell’era A, Pappalardo E, Mannucci PM. Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology. 2005;41(3):603-608. doi: 10.1002/hep.20591.
5. Pleassier A, Murad SD, Hernandez-Guerra M. A prospective multicentric follow-up study on 105 patients with acute portal vein thrombosis 249 (PVT): results from the European Network for Vascular Disorders of the Liver (ENVIE). Hepatology. 2007;46(Suppl 1):310A.
6. Smalberg JH, Arends LR, Valla DC, Kiladjian JJ, Janssen HL, Leebeek FW. Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a metaanalysis. Blood. 2012;120(25):4921-4928. doi: 10.1182/blood-2011-09-376517.
7. Hoekstra J, Bresser EL, Smalberg JH, Spaander MC, Leebeek FW, Janssen HL. Long-term follow-up of patients with portal vein thrombosis and myeloproliferative neoplasms. Journal of Thrombosis and Haemostasis. 2011;9(11):2208-2214. doi: 10.1111/j.1538-7836.2011.04484.x.
8. D’Amico M, Sammarco P, Pasta L. Thrombophilic genetic factors PAI-1, MTHFRC677T, V Leiden 506Q, and prothrombin 20210A in noncirrhotic portal vein thrombosis and Budd-Chiari syndrome in a Caucasian population. International Journal of Vascular Medicine. 2013;2013:717480. doi: 10.1155/2013/717480.
9. Qi X, De Stefano V, Wang J, Bai M, Yang Z, Han G, Fan D. Prevalence of inherited antithrombin, protein C, and protein S deficiencies in portal vein system thrombosis and Budd-Chiari syndrome: a systematic review and meta-analysis of observational studies. Journal of Gastroenterology and Hepatology. 2013;28(3):432-442. doi: 10.1111/jgh.12085.
10. Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR. Management of acute non-cirrhotic non malignant portal vein thrombosis: a systematic. World Journal of Surgery. 2011;35(11):2510-2520. doi: 10.1007/s00268-011-1198-0.
11. Dolovich LR, Ginsberg JS, Douketis JD, Holbrook AM, Cheah G. A meta-analysis comparing low-molecular wtheparin with unfractionated heparin in treatment of venous thrombolism examining some unanswered questions regarding location of treatment product use and dosing frequency. Archives of Internal Medicine. 2000;160(2):181-188.
