Coated Transjugular Intrahepatic Portosystemic Shunt Does Not Improve Thrombocytopenia in Patients with Liver Cirrhosis

Abstract

Background/Aim

Thrombocytopenia is a common complication of chronic liver disease. The theory of portal decompression to improve thrombocytopenia due to hypersplenism has led to the study of transjugular intrahepatic portosystemic shunt (TIPS) as a potential therapy. However, there is a paucity of data and results have been conflicting. The aim of this study was to determine whether platelet counts improved in cirrhotic patients after placement of the new polytetrafluoroethylene (PTFE)-coated TIPS, developed in 2004.

Methods

This is a retrospective cohort study of 68 patients with chronic liver disease who underwent a TIPS procedure. One-hundred twenty controls who did not undergo a TIPS procedure were matched on average for age, sex, race, model for end-stage liver disease (MELD) score, and etiology of liver disease. Platelet and hemoglobin counts were recorded during the month prior to the TIPS procedure (baseline) and over the following 12–14 months or until transplanted or death.

Results

While platelet counts improved during the first 3 months after TIPS with a mean increase of 11.25 × 103/μL (p = 0.064), they returned to baseline (pre-TIPS) with mean platelets of 91.31 × 103 μL by 12–14 months in comparison with a mild decrease of 10.2 × 103 μL in platelet counts in the control group from 100.4 × 103 μL to 90.2 × 103 (p = 0.119). There was also no significant correlation between platelet counts and etiology of liver disease, age, race, gender, or MELD score. Hemoglobin counts were found to have a small increase of 0.657 g/dL over the 12–14 month course in the TIPS group, which was statistically significant (p = 0.003).

Conclusion

There does not appear to be a significant improvement in thrombocytopenia in cirrhotic patients after TIPS placement, despite advances in TIPS stents. However, there may be a mild improvement in anemia after TIPS implantation.

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Fig. 1

Abbreviations

DIC:

Disseminated intravascular coagulation

ITP:

Idiopathic thrombocytopenic purpura

TIPS:

Transjugular intrahepatic portosystemic shunt

e-PTFE:

Polytetrafluoroethylene

MELD:

Model for end-stage liver disease

HCC:

Hepatocellular carcinoma

HIV:

Human immunodeficiency virus

OLT:

Orthotopic liver transplantation

INR:

International normalized ratio

EGD:

Esophagogastroduodenoscopy

GI:

Gastrointestinal

HCV:

Hepatitis C virus

NAFLD:

Non-alcoholic fatty liver disease

PLT:

Platelets

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Acknowledgments

The authors are indebted to the Interventional Radiology staff at Banner Good Samaritan Medical Center for performing the TIPS procedures and for providing a list of patients who underwent TIPS for enrollment in the study.

Conflict of interest

The above authors have no commercial affiliations or conflicts of interest to disclose.

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Correspondence to Elise J. Barney.

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Barney, E.J., Little, E.C., Gerkin, R.D. et al. Coated Transjugular Intrahepatic Portosystemic Shunt Does Not Improve Thrombocytopenia in Patients with Liver Cirrhosis. Dig Dis Sci 57, 2430–2437 (2012). https://doi.org/10.1007/s10620-012-2162-z

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Keywords

  • TIPS
  • Thrombocytopenia
  • Cirrhosis
  • Platelets
  • Hypersplenism