Abstract
Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Most reports conclude that portocaval and distal splenorenal shunts do not improve platelet counts in this setting. The response of thrombocytopenia after transjugular intrahepatic portosystemic shunt placement has not been studied. All platelet counts of 21 patients undergoing intrahepatic shunt placement were determined retrospectively to accumulate values at one month prior to procedure, weekly for the first month after the procedure, and monthly thereafter to six months. Comparison of pre- and postshunt platelet means showed a significant increase in counts in patients with a postshunt portal pressure gradient <12 mm Hg, with the increment evident by one week after the procedure. This response was not seen when preshunt thrombocytopenia was used as the lone variable. This study suggests that the transjugular intrahepatic portosystemic shunt may improve the thrombocytopenia associated with liver cirrhosis when these pressure gradients are attained.
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Toghill PJ, Green S: Platelet dynamics in chronic liver disease using the 111-indium oxide label. Gut 24:49–52, 1983
Schmidt KG, Rasmussen JW, Bekker C, Madsen PER: Kinetics andin vivo distribution of 111-In-labeled autologous platelets in chronic hepatic disease: Mechanisms of thrombocytopenia. Scand J Hematol 34:39–46, 1985
Landolfi R, Leone G, Fedeli G, Storti S, Laghi F, Bizzi B: Platelet-associated IgG in acute and chronic hepatic diseases. Scand J Hematol 25:417–422, 1980
DeNoronha R, Taylor BA, Wild G, Triger DR, Greaves M: Interrelationships between platelet count, platelet IgG, serum IgG, immune complexes and severity of liver disease. Clin Lab Hematol 13:127–135, 1991
Paramo JA, Rocha E: Hemostasis in advanced liver disease. Semin Thromb Hemost 19:184–190, 1993
Aseni P, Beati CA, Vertemati M, Meroni A, Belli L: Liver arterialization prevents thrombocytopenia after portacaval shunt in rats. Eur Surg Res 19:159–163, 1987
Felix WR, Myerson RM, Sigel B, Perrin EB, Jackson FC: The effect of portacaval shunt on hypersplenism. Surg Gynecol Obsetet 139:899–904, 1974
Hutson DG, Zeppa R, Levi JU, Schiff ER, Livingstone AS, Fink P: The effect of the distal splenorenal shunt on hypersplenism. Ann Surg 185:605–610, 1977
Mutchnick MG, Lerner E, Conn HO: Effect of portacaval anastomosis on hypersplenism in cirrhosis: A prospective controlled evaluation. Gastroenterology 68:1070, 1975
Mutchnick MG, Lerner E, Conn HO: Effect of portacaval anastomosis on hypersplenism. Dig Dis Sci 25:929–938, 1980
Morris PW, Patton TB, Balint JA, Hirschowitz BI: Portal hypertension, congestive splenomegaly and portacaval shunt. Gastroenterology 42:555–559, 1962
Puttini M, Marni A, Montes F, Belli L: Effect of portasystemic shunt on hypersplenism: clinical study in 129 patients with cirrhosis. Am Surg 45:444–448, 1979
Yanaga K, Tzakis AG, Shimada M, Campbell WE, Marsh JW, Stieber AC, Makowka L, Todo S, Gordon RD, Iwatsuki S, Starzl TE: Reversal of hypersplenism following orthotopic liver transplantation. Ann Surg 210:180–183, 1989
Luzzatto G, Fabris F, Gerunda GE, Maffei-Faccioli A, Naccarato R, Girolami A: Thrombocytopenia in liver cirrhosis complicated by variceal hemorrhage: Lack of increase in platelet count after splenorenal distal shunt. Folia Haematol Int Mag Klin Morphol Blutforsch 114:145–152, 1987
Ring EJ, Lake JR, Roberts JP, Gordon RL, LaBerge JM, Read AE, Sterneck MR, Ascher NL: Using transjugular intrahcpatic portosystemic shunts to control variceal bleeding before liver transplantation. Ann Intern Med 116:304–309, 1992
Rossle M, Haag K, Ochs A, Sellinger M, Noldge G, Perarnau JM, Berger E, Blum U, Gabelmann A, Hauenstein K, Langer M, Gerok W: The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 330:165–171, 1994
Martin M, Zajko AB, Orons PD, Dodd G, Wright H, Colangelo J, Tartar R: Transjugular intrahepatic portosystemic shunt in the management of variceal bleeding: Indications and clinical results. Surgery 114:719–726, 1993
LaBerge JM, Ring EJ, Gordon RL, Lake JR, Doherty MM, Somberg KA, Roberts JP, Ascher NL: Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: Results in 100 patients. Radiology 187:413–420, 1993
Ferral H, Bjarnason H, Wegryn SA, Rengel GJ, Nazarian GK, Rank JM, Tadavarthy SM, Hunter DW, Castaneda-Zuniga WR: Refractory ascites: Early experience in treatment with transjugular intrahepatic portosystemic shunt. Radiology 189:795–801, 1993
Laird NM, Ware JH: Random-effects models for longitudinal data. Biometrics 38:963–974, 1982
SAS Institute Inc: SAS Technical Report P-229, SAS/STAT Software: Changes and Enhancements, Release 6.07. Cary, North Carolina, SAS Institute Inc., 1992, 620 pp
Sullivan BH, Tumen HF: The effect of portacaval shunt on thrombocytopenia associated with portal hypertension. Ann Intern Med 55:593–603, 1961
Skootsky SA, Rosove MH, Langley MB: Immune thrombocytopenia and response to splenectomy in chronic liver disease. Arch Intern Med 146:555–557, 1986
Viallet A, Marleau D, Huet M, Martin F, Farley A, Villeneuve JP, Lavoie P: Hemodynamic evaluation of patients with intrahepatic portal hypertension: Relationship between bleeding varices and the porto-hepatic gradient. Gastroenterology 69:1297–1300, 1975
Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M: Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5:419–424, 1985
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This study was supported by NIAK08AG00619-01A1 and PHS grant 5 P30 DK34914 to B.M. Bilir from the University of Colorado, Hepatobiliary Research Center.
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Lawrence, S.P., Lezotte, D.C., Durham, J.D. et al. Course of thrombocytopenia of chronic liver disease after transjugular intrahepatic portosystemic shunts (TIPS). Digest Dis Sci 40, 1575–1580 (1995). https://doi.org/10.1007/BF02285211
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DOI: https://doi.org/10.1007/BF02285211