If this proved true for portal vein thrombosis, hasting recogniti

If this proved true for portal vein thrombosis, hasting recognition and therapy of this rare condition, would be crucial for improving results on a population basis. Although a recovered patency of the portal vein and at least one main branch was reached in one-third

of patients receiving anticoagulation therapy, obstruction of the portal vein or both of its two main branches persisted until the end of follow-up in the rest. The latter patients will probably develop permanent portal hypertension because no recanalization occurred between 6 and 12 months after anticoagulation began. Indeed, click here a portal cavernoma had already developed in 40% of patients by the end of follow-up. Thus, early anticoagulation is less effective in inducing recanalization of complete extrahepatic portal vein obstruction than in preventing extension to or from the portal vein. Nevertheless, recanalization rates approached 60% in superior mesenteric and splenic veins. This outcome is clinically significant, because a preserved mesenteric vein is a major predictor of long-term survival.21 Moreover,

recanalization of these veins steadily increased during follow-up. Further studies are needed to assess whether anticoagulation should be maintained until recanalization of these veins. Finally, the absence of PVT-related deaths in this cohort is remarkable, especially because most of these patients had extensive thrombosis of the portal venous system at inclusion.21 In patients with acute PVT, the baseline risk of bleeding can be increased by portal hypertension Etoposide and intestinal Meloxicam ischemia. Although 5% of our patients experienced major bleeding, there were no bleeding-related deaths. It should be noted that this rate of severe bleeding is similar to that observed with anticoagulation for deep vein thrombosis at other sites.22 Multivariate analyses disclosed that patients with a combination of splenic vein obstruction and ascites have very little chance of recanalization

during anticoagulation. It is noteworthy that underlying risk factors for venous thrombosis did not bring additional independent information. Furthermore, the type of anticoagulation initially given (unfractionated heparin, low-molecular-weight heparin, or oral vitamin K antagonists) did not appear to impact on recanalization. Additional or alternative therapeutic options should be considered to increase the recanalization rate, but current options include high-risk procedures. Pharmacological or instrumental thrombolysis have recently been proposed by a direct, percutaneous transhepatic approach to the portal vein, or by superior mesenteric artery catherization.4, 23–25 These invasive, poorly evaluated procedures should only be considered for patients with the least chance of recanalization during anticoagulation therapy.

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