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Journal of Gastrointestinal Cancer

, Volume 50, Issue 4, pp 759–762 | Cite as

Acute Portal Vein Thrombosis Predicts Concomitant Diagnosis of Hepatocellular Carcinoma in Cirrhotic Patients

  • Tawfik KhouryEmail author
  • Muhammad Massarwa
  • Wadi Hazou
  • Saleh Daher
  • David Hakimian
  • Ariel A. Benson
  • Toni Ashqar
  • Mahmud Mahamid
  • Shaul Yaari
Original Research

Abstract

Purpose

Portal vein thrombosis (PVT) is a common condition in cirrhotic patients and mostly attributed to portal hypertension. The objective of our study was to examine the association of PVT with hepatocellular carcinoma (HCC) in cirrhotic patients.

Methods

A retrospective study was performed to identify cirrhotic patients with thrombosis of the portal system. Clinical and laboratory characteristics were collected and analyzed.

Results

Thirty-nine patients were identified. Twenty-four out of 39 patients with PVT did not develop HCC (group A) after follow-up time of 38.5 months from the diagnosis of PVT. Eight patients (20.5%) were diagnosed with HCC within two weeks following diagnosis of PVT (group B). Seven patients (17.9%) were diagnosed with tumor thrombus (group C) at time of PVT diagnosis. The average age was 53.5, 66.5, and 69 years for groups A, B, and C respectively. Most patients (75 and 87.5% for groups B and C respectively) diagnosed with PVT and HCC were males. The most common cause of cirrhosis in groups B and C was chronic hepatitis B virus infection (HBV) in 62.5% and 50% respectively. The most common clinical presentation of PVT in group A was abdominal pain in 55.5% compared to new/worsening ascites in 43% and 37.5% for groups B and C respectively. The platelet count in groups B and C was higher as compared to that in group A (126 and 125 vs. 107 thousand, P = NS).

Conclusion

In 38.4% of cases, new diagnosis of PVT was associated with concomitant diagnosis of HCC. Identifiable risk factors were chronic HBV infection and higher platelet count.

Keywords

Portal vein thrombosis Cirrhosis Hepatocellular carcinoma HBV infection 

Abbreviations

PVT

Portal vein thrombosis

HCC

Hepatocellular carcinoma

MELD

Model for end-stage liver disease

HBV

Hepatitis B virus

HCV

Hepatitis C virus

NASH

Non-alcoholic steatohepatitis

USD

Doppler ultrasonography

CT

Computed tomography

VTE

Venous thromboembolism

ICD

International Statistical Classification of Diseases and Related Health Problems

MRI

Magnetic resonance imaging

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005;54(5):691–7.CrossRefGoogle Scholar
  2. 2.
    Tripodi A, et al. Hypercoagulability in cirrhosis: causes and consequences. J Thromb Haemost. 2011;9(9):1713–23.CrossRefGoogle Scholar
  3. 3.
    Zocco MA, di Stasio E, de Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol. 2009;51(4):682–9.CrossRefGoogle Scholar
  4. 4.
    Bechmann LP, Wichert M, Kröger K, Hilgard P. Dosing and monitoring of low-molecular-weight heparin in cirrhotic patients. Liver Int. 2011;31(7):1064.CrossRefGoogle Scholar
  5. 5.
    Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–56.CrossRefGoogle Scholar
  6. 6.
    Hollestelle MJ, Geertzen HG, Straatsburg IH, van Gulik T, van Mourik J. Factor VIII expression in liver disease. Thromb Haemost. 2004;91(2):267–75.CrossRefGoogle Scholar
  7. 7.
    Biagini MR, Tozzi A, Marcucci R, Paniccia R, Fedi S, Milani S, et al. Hyperhomocysteinemia and hypercoagulability in primary biliary cirrhosis. World J Gastroenterol. 2006;12(10):1607–12.CrossRefGoogle Scholar
  8. 8.
    Mangia A, Margaglione M, Cascavilla I, Gentile R, Cappucci G, Facciorusso D, et al. Anticardiolipin antibodies in patients with liver disease. Am J Gastroenterol. 1999;94(10):2983–7.CrossRefGoogle Scholar
  9. 9.
    Qi X, Han G, Fan D. Management of portal vein thrombosis in liver cirrhosis. Nat Rev Gastroenterol Hepatol. 2014;11(7):435–46.CrossRefGoogle Scholar
  10. 10.
    Primignani M. Portal vein thrombosis, revisited. Dig Liver Dis. 2010;42(3):163–70.CrossRefGoogle Scholar
  11. 11.
    Mangia A, Villani MR, Cappucci G, Santoro R, Ricciardi R, Facciorusso D, et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors. Eur J Gastroenterol Hepatol. 2005;17(7):745–51.CrossRefGoogle Scholar
  12. 12.
    Bruix J, Sherman M, D. American Association for the Study of Liver. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.CrossRefGoogle Scholar
  13. 13.
    Llado L, et al. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality. Clin Transpl. 2007;21(6):716–21.Google Scholar
  14. 14.
    DeLeve LD, et al. Vascular disorders of the liver. Hepatology. 2009;49(5):1729–64.CrossRefGoogle Scholar
  15. 15.
    Shah V. Molecular mechanisms of increased intrahepatic resistance in portal hypertension. J Clin Gastroenterol. 2007;41(Suppl 3):S259–61.CrossRefGoogle Scholar
  16. 16.
    Lertpipopmetha K, Auewarakul CU. High incidence of hepatitis B infection-associated cirrhosis and hepatocellular carcinoma in the Southeast Asian patients with portal vein thrombosis. BMC Gastroenterol. 2011;11:66.CrossRefGoogle Scholar
  17. 17.
    Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Am J Gastroenterol. 2013;108(4):568–74.CrossRefGoogle Scholar
  18. 18.
    Lisman T, Porte RJ. The role of platelets in liver inflammation and regeneration. Semin Thromb Hemost. 2010;36(2):170–4.CrossRefGoogle Scholar
  19. 19.
    John BV, Konjeti R, Aggarwal A, Lopez R, Atreja A, Miller C, et al. Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis. Ann Hepatol. 2013;12(6):952–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tawfik Khoury
    • 1
    • 2
    Email author
  • Muhammad Massarwa
    • 1
    • 2
  • Wadi Hazou
    • 1
    • 3
  • Saleh Daher
    • 1
    • 2
  • David Hakimian
    • 1
    • 2
  • Ariel A. Benson
    • 1
    • 4
  • Toni Ashqar
    • 1
  • Mahmud Mahamid
    • 5
  • Shaul Yaari
    • 1
  1. 1.Institute of Gastroenterology and Liver Diseases, Department of Internal MedicineHebrew University-Hadassah Medical CenterJerusalemIsrael
  2. 2.The Liver Unit, Institute of Gastroenterology and Liver Diseases, Division of Internal MedicineHebrew University-Hadassah Medical CenterJerusalemIsrael
  3. 3.The Liver Unit, Institute of Gastroenterology and Liver DiseasesHebrew University-Hadassah Medical CenterJerusalemIsrael
  4. 4.Institute of Gastroenterology and Liver DiseasesHebrew University-Hadassah Medical CenterJerusalemIsrael
  5. 5.Gastroenterology and Endoscopy UnitedThe Nazareth Hospital, EMMSNazarethIsrael

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