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Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry

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An Erratum to this article was published on 23 September 2016

Abstract

Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected portal vein thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the portal vein thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with portal vein thrombosis. Portal vein thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with portal vein thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.

Clinicaltrials.gov identifier NCT01470547.

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Authors and Affiliations

  1. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Francesco Violi, Laura Napoleone, Valeria Raparelli & Stefania Basili

  2. First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

    Roberto Gino Corazza & Michela Masotti

  3. Division of Gastroenterology and Hepatology, Digestive Health Center, University of Virginia, Charlottesville, VA, USA

    Stephen Hugh Caldwell

  4. Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy

    Francesco Perticone

  5. Department of Medicine, University of Padova, Padua, Italy

    Angelo Gatta

  6. Liver Unit, University Hospital Tor Vergata, Rome, Italy

    Mario Angelico

  7. Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy

    Alessio Farcomeni & Annarita Vestri

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  1. Francesco Violi
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  2. Roberto Gino Corazza
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  4. Francesco Perticone
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  8. Michela Masotti
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  9. Laura Napoleone
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Consortia

PRO-LIVER Collaborators

Corresponding author

Correspondence to Francesco Violi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial support

Nothing to declare.

Additional information

The members of PRO-LIVER Collaborators are listed in Appendix section.

An erratum to this article is available at http://dx.doi.org/10.1007/s11739-016-1540-5.

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PRO-LIVER Study Collaborators

PRO-LIVER Study Collaborators

Palasciano Giuseppe, D’Alitto Felicia, Palmieri Vincenzo Ostilio, Santovito Daniela (Clinica Medica, UOC Medicina Interna Universitaria “A. Murri”), Di Michele Dario, Croce Giuseppe (U.O.C. di Medicina Interna - Ospedale “G.Mazzini” ASL Teramo), Sacerdoti David, Brocco Silvia, Fasolato Silvano, Cecchetto Lara, Bombonato Giancarlo (Department of Medicine, University of Padova, Padova, Italy), Bertoni Michele, Restuccia Tea (U.O.C. Medicina Interna 2, Nuovo Ospedale di Prato), Andreozzi Paola, Liguori Maria Livia (Centro di Medicina Predittiva, prevenzione e cura della malattie cronicodegenerative e controllo dei fattori di rischio, Azienda Policlinico Umberto I, Roma), Perticone Francesco, Caroleo Benedetto, Perticone Maria, Staltari Orietta (Department of Medical and Surgical Sciences, University of Catanzaro; UO Malattie Cardiovascolari Geriatriche, Policlinico Mater Domini di Catanzaro; Dipartimento di Medicina Sperimentale e Clinica, Università Magna Graecia di Catanzaro; Dipartimento Scienze della Salute, Università Magna Graecia di Catanzaro), Manfredini Roberto, De Giorgi Alfredo (UOC Clinica Medica, Azienda Ospedaliero - Universitaria di Ferrara), Averna Maurizio, Giammanco Antonina (Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo), Granito Alessandro, Pettinari Irene, Marinelli Sara, Bolondi Luigi (U.O. Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche,Università di Bologna), Falsetti Lorenzo, Salvi Aldo (Medicina Interna Generale e Subintensiva - Ospedali Riuniti di Ancona), Durante-Mangoni Emanuele, Cesaro Flavio, Farinaro Vincenza, Ragone Enrico (Medicina Infettivologica e dei Trapianti, Seconda Università di Napoli), Morana Ignazio (U.O. Medicina Interna Area Critica, ARNAS “Garibaldi” Catania), Andriulli Angelo, Ippolito Antonio, Iacobellis Angelo, Niro Grazia, Merla Antonio (Gastroenterologia ed Endoscopia Digestiva-Casa Sollievo della Sofferenza –Ospedale-IRCCS San Giovanni Rotondo), Raimondo Giovanni, Maimone Sergio, Cacciola Irene, Varvara Doriana (Division of Clinical and Molecular Hepatology, Department of Internal Medicine University Hospital of Messina), Drenaggi Davide, Staffolani Silvia (Clinica Malattie Infettive Tropicali, Parassitologia, Epatiti croniche Azienda Ospedaliero Universitaria “Ospedali Riuniti”), Picardi Antonio, Vespasiani-Gentilucci Umberto, Galati Giovanni, Gallo Paolo (UOS Medicina Clinica, Epatologia Università Campus Bio-Medico), Davì Giovanni, Schiavone Cosima, Santilli Francesca, Tana Claudio (UO Patologia Medica, Ospedale Clinicizzato “SS. Annunziata” Chieti), Licata Anna, Soresi Maurizio (UOC di Medicina Interna ed Epatologia, DIBIMIS, Università di Palermo), Bianchi Giovanni Battista, Carderi Isabella (UOC di Medicina Generale dell’Ospedale “SS. Capitanio e Gerosa” di Lovere), Pinto Antonio, Tuttolomondo Antonino (Unità Operativa Complessa di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo), Ferrari Giovanni (U.O.C. di Medicina Interna, Ospedale “SS.Annunziata” di Varzi, A.O della Provincia di Pavia), Gresele Paolo, Fierro Tiziana, Morelli Olivia (S.S. di Diagnosi e Terapia delle Malattie Emorragiche e Laboratorio delle Malattie Tromboemboliche; S.C. Medicina Interna e Cardiovascolare, Dipartimento di Medicina; S.C. Gastroenterologia ed Epatologia, Università - Azienda Ospedaliera di Perugia), Laffi Giacomo, Romanelli Roberto Giulio, Arena Umberto, Stasi Cristina (Azienda Ospedaliero Universitaria Careggi , Unita’ Operativa Complessa Medicina Interna ed Epatologia, Firenze), Gasbarrini Antonio, Gargovich Matteo, Zocco Maria Assunta, Riccardi Laura, Ainora Maria Elena (U.O.C. Medicina Interna e Gastroenterologia, Policlinico Gemelli, Roma), Capeci William, Martino Giuseppe Pio, Nobili Lorenzo (Clinica Medica Generale - AOU  “Ospedali Riuniti” Ancona), Cavallo Maurizio (Medicina di Arzignano/Lonigo –ULSS 5 Ovest Vicentino), Frugiuele Pierluigi, Greco Antonio (Struttura Complessa di Medicina Interna e Reumatologia Azienda Ospedaliera di Cosenza), Pietrangelo Antonello, Ventura Paolo, Cuoghi Chiara, Marcacci Matteo (Divisione Medicina Interna 2 / CEMEF e Centro Dipartimentale di Ricerca Epatologica Avanzata “Mario Coppo”, Azienda Ospedaliero-Universitaria Policlinico di Modena), Serviddio Gaetano, Vendemiale Gianluigi, Villani Rosanna, Gargano Ruggiero (Centro Universitario per la ricerca e cura delle malattie epatiche - Clinica Medica Universitaria, Foggia), Vidili Gianpaolo, Di Cesare Valentina, Masala Maristella, Delitala Giuseppe (Clinica Medica , Azienda Ospedaliero Universitaria Sassari), Invernizzi Pietro (Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano), Di Minno Giovanni, Tufano Antonella (Centro di Coordinamento Regionale per le Emocoagulopatie, AOU Federico II Napoli), Purrello Francesco, Privitera Graziella (Dipartimento di Medicina Clinica e Sperimentale Università di Catania, UOC di Medicina Interna Ospedale Garibaldi-Nesima, Catania), Forgione Alessandra, Curigliano Valentina (IRCCS San Raffaele Pisana Roma), Senzolo Marco, Rodríguez-Castro Kryssia Isabel (Unità Trapianto Multiviscerale, Gastroenterologia, Università Ospedale Di Padova), Giannelli Gianluigi (Dipartimenti delle Emergenze e dei Trapianti di Organo, Sezione di Medicina Interna, Allergologia ed Immunologia Clinica, Bari), Serra Carla (Ecografia diagnostica ed interventistica, Dipartimento delle Insufficienze d’organo e dei Trapianti, Policlinico S.Orsola-Malpighi, Bologna), Neri Sergio (UOC di Medicina Interna “A. Francaviglia”, Policlinico Universitario di Catania), Pignataro Pietro (UOC I Medicina Interna, AOU Policlinico Vittorio Emanuele, Catania), Rizzetto Mario, Debernardi Venon Wilma (UOADU Gastroepatologia, Azienda Ospedaliera San Giovanni Battista Di Torino), Svegliati Baroni Gianluca (Clinica di Gastroenterologia, Ancona), Bergamaschi Gaetano, Masotti Michela, Costanzo Filippo (I° Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy), Angelico Francesco, Del Ben Maria, Napoleone Laura, Polimeni Licia, Raparelli Valeria, Talerico Giovanni, Proietti Marco, Romiti Giulio Francesco, Ruscio Eleonora, Toriello Filippo (I Clinica Medica, Sapienza University of Rome, Italy).

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Violi, F., Corazza, R.G., Caldwell, S.H. et al. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry. Intern Emerg Med 11, 1059–1066 (2016). https://doi.org/10.1007/s11739-016-1416-8

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