Journal article
A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia
Alimentary Pharmacology and Therapeutics, Vol.50(9), pp.1049-1058
2019
PMID: 31489698
Abstract
Background:
Anticoagulation alone in acute, extensive portomesenteric vein thrombosis (PVT) does not always result in spontaneous clot lysis, and leaves the patient at risk of complications including intestinal infarction and portal hypertension.
Aim:
To develop a new standard of care for patients with acute PVT and evidence of intestinal ischaemia.
Methods:
We present a case series of patients with acute PVT and evidence of intestinal ischaemia plus ongoing symptoms despite initial systemic anticoagulation, who were treated with a thrombolysis protocol between 2014 and 2019. This stepwise protocol initially uses low-dose systemic alteplase, and in patients with ongoing abdominal pain, and no evidence of radiological improvement, is followed by local clot dissolution therapy (CDT) through a TIPSS. Outcomes and safety were assessed.
Results:
Twenty-two patients were included. The mean age was 44.6 (standard deviation [SD] 16.0) years, and 64% had an identifiable prothrombotic risk factor. All patients had intestinal wall oedema and 77% had complete occlusion of all portomesenteric veins. Systemic thrombolysis was started 18.7 (SD 11.2) days after the onset of symptoms. 55% of patients underwent TIPSS insertion for CDT. At the end of treatment, symptoms resolved in 91% of patients and recanalisation in 86%. Only one patient required resection for intestinal ischaemia, and there were no deaths. Major complications occurred in two patients (9%).
Conclusions:
Our stepwise protocol is effective, resulting in good recanalisation rates. It can be commenced early while organising transfer to a centre capable of performing local CDT.
Details
- Title
- A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia
- Authors
- Amine Benmassaoud (Author) - Royal Free London NHS Foundation TrustLaith AlRubaiy (Author) - Royal Free London NHS Foundation TrustDominic Yu (Author) - Royal Free London NHS Foundation TrustPratima Chowdary (Author) - Royal Free London NHS Foundation TrustMallika Sekhar (Author) - Royal Free London NHS Foundation TrustPathik Parikh (Author) - Royal Free London NHS Foundation TrustJemima Finkel (Author) - Royal Free London NHS Foundation TrustTeik Choon See (Author) - Addenbrooke's HospitalJames O'Beirne (Author) - Sunshine Coast University HospitalJoanna A Leithead (Author) - Addenbrooke's HospitalDavid Patch (Corresponding Author) - Royal Free London NHS Foundation Trust
- Publication details
- Alimentary Pharmacology and Therapeutics, Vol.50(9), pp.1049-1058
- Publisher
- Wiley-Blackwell Publishing Ltd.
- Date published
- 2019
- DOI
- 10.1111/apt.15479
- ISSN
- 1365-2036
- PMID
- 31489698
- Organisation Unit
- University of the Sunshine Coast, Queensland; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99609707702621
- Output Type
- Journal article
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- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Gastroenterology & Hepatology
- Pharmacology & Pharmacy
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Source: InCites