STUDIO SULL'EFFICACIA DELLA TERAPIA ANTICOAGULANTE NEI PAZIENTI CON TROMBOSI PORTALE AFFETTI DA CIRROSI EPATICA
Creators: name: IANNUZZI, FRANCESCA
Publisher: name: Universit� degli Studi di Milano
Year: 2012

description: Background &amp; Aims: Portal Vein thrombosis defines the presence of a thrombus, blocking completely or partially the vein in the trunck of the portal vein or in its intrahepatic collaterals . For patients whit cirrhosis, it means a preexisting HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=hypertension%20portal&amp;cmd=correctspelling" portal hypertension getting worth adding a presinusoidal part to it. The TP, if complete, can block the liver transplantation. The aim of this study is to check the efficiency of the anticoagulant oral therapy with heparina in a group of patients affected with epathic cyrrhosis or TP, to value the symptoms of occurances of the TP and the variations of the Child-Pugh score according to the appearance of the resolution or the eventual extension of the TP. Methods: This study has been established in a consecutive range of 66 patients enroled retrospectively, affected with CE and trombose of the Portal system, referred to our unit from January 1996 and April 2010. These patients were followed whit blood exams, abdomen ultrasound computerized axial tomogrphy,endoscopy. Results: At the time of the TP diagnosis, 17% of the patients belonged to the Child-Pugh A class, 68% to the Child-Pugh B class and 6% to the Child-Pugh C class. 44 Patients (66,7%) has done anticoagulant oral therapy, 17(39%) patients were following the terapia con eparina a basso peso molecolare, 23(52%) patients were following a therapy with Coumadin and 4(9%) were following both therapy alternatively. Average time of treatment was 38 � 4 months for the group taking Coumadin, 23 � 3 months for the group taking Eparina a basso peso molecolare. 2 patients were taking eparina for 8 � 1 months and then 39 � 15 months. 2 patients were taking Coumadin for 5 � 2 months and then eparina for 13 � 5 mesi. During the follow-up, 24 patients out of 66 (36%) have obtained a complete resolution( 4 patients without therapy and 20 taking an anticoagulant treatment : 4 patients in therapy with heparin, 12 patients with Coumadin, 4 patients with both simultaneously.) The partial recanalization was obtained for 28 patients (42%) (4 patients without therapy, 24 patients under an anticoagulant therapy : 8 patients following a therapy with heparin, 14 following a therapy with Coumadin and 2 following both at the same time. We can observe an extansion for the trombose for 31 patients out of 66 (47%) from which 25 outside of the anticoagulant therapy and 6 during it (2 patients following the heparin therapy, 3 patients with Coumadin and 1 patient following both simultaneously. 20 patients had portal cavernous (for 7 patients it was already diagnosed, for 13 patients it appeared during the follow-up from which 4 patients were not following any therapy, 5 an heparin therapy, 3 an Coumadin therapy and 1 both simultaneously. Conclusions: The anticoagulant therapy were proved efficient in the recanalization of the TP during the follow-up (p=0,032). The anticoagulant therapy were proved efficient in the partial recanalization of the portal vein thrombosis (p=0,018). Undertaking the anticoagulant therapy did not have a significative impact on the progression of portal vein thrombosis (p=0,168) at the follow-up. The anticoagulant therapy did not prevent the develop of caverous (p=0,741).