Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development

Maria Assunta Zocco, Enrico Di Stasio, Raimondo De Cristofaro, Marialuisa Novi, Maria Elena Ainora, Francesca Ponziani, Laura Riccardi, Stefano Lancellotti, Angelo Santoliquido, Roberto Flore, Maurizio Pompili, Gian Lodovico Rapaccini, Paolo Tondi, Giovanni Battista Gasbarrini, Raffaele Landolfi, Antonio Gasbarrini
Journal of Hepatology 2009, 51 (4): 682-9

BACKGROUND/AIMS: Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients.

METHODS: One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression.

RESULTS: The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development.

CONCLUSIONS: Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.

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