الفهرس 
CONTENTS
Coagulopathy in Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
Portal vein thrombosis (PVT) is considered a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions that worsens the prognosis of cirrhosis such as gastroesophageal bleeding and acute intestinal ischemia.
The current study aimed to assess the frequency of PVT in cirrhotic patients, to differentiate between benign and malignant PVT and to determine the risk factors to develop PVT in cirrhotic patients.
A total of 420 cirrhotic patients admitted to Al-Rajhi Liver center, Assiut University Hospital, Egypt between Mai and November 2016 were included in the study. Of them, 50 (12%) patients had PVT based on abdominal imaging with ultra-sonography and confirmed with contrast enhanced MSCT abdomen and 120 patients did not have PVT were selected as a control group.
All individuals were subjected to:
- Full medical history and physical examination
- Liver function tests
- Blood urea and serum creatinine, Random blood sugar
- Alpha feto-protein
- Abdominal ultrasonography and abdominal Doppler
- Abdominal multi-slice computed tomography with contrast (MSCT) for patients with PVT only
- Serum protein C and S and anti-thrombin III, and D-dimer
The following results were observed:
- Half of cases had malignant PVT, 62% had completely occluded portal vein and 58% had chronic PVT.
- The common site for PVT was the main trunk and both branches (26%) followed by the main trunk (24%) where the main trunk and left branch had the least frequency for PVT (8%).
- Cirrhotic patients with PVT were younger age, male predominance, had increased severity of liver disease and higher frequency of HCC.
- The majority of patients with PVT presented with abdominal pain (54%) and GIT bleeding occur only 12% of patients.
- Patients with PVT had significantly lower Hb, serum albumin and higher D-dimer levels. While protein S deficiency was common in patients without PVT. On the other hand, protein C and anti-thrombin III had no differences between those with PVT and those without.
- Other laboratory data included CBC, liver function tests, kidney function test and INR had no statistical differences between those with PVT and those without.
- Patients with HCC had significantly higher frequency of malignant PVT (67.6%) and 32.4% were benign PVT.
- No statistical significance differences between patients with malignant and benign PVT regarding clinical, laboratory and imaging characteristics except for higher HCC frequency in patients with malignant PVT and slightly higher D-dimer level in those with benign PVT.
- The only significant difference between both groups with partial and complete PVT was the site of PVT where the partial PVT at right branch of portal vein was the commonest (P value < 0.001).
- The only significant differences between both groups with acute and chronic PVT where serum bilirubin levels were significantly higher in patients with chronic PVT.
- low hemoglobin level and elevated d-dimer were independent risk factors for PVT development in patients with liver cirrhosis
- D-dimer had the higher AUC (0.959) that was statistically significant (P value < 0.001), where 88% of cirrhotic patients had PVT at a cut-off point > 0.33 µg/ml with 84% sensitivity, 91.7% specificity, 80.8% PPV, 93.2% NPV and 10.1 +LR so it was a good predictor for PVT development.