Reassessing the role of medical therapy in the management of hepatic vein thrombosis

A. D. Min, E. O. Atillasoy, M. E. Schwartz, M. Thiim, C. M. Miller, Jr Bodenheimer, A. N. Langnas

Research output: Contribution to journalArticle

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Abstract

Hepatic venous outflow obstruction caused by hepatic vein thrombosis (HVT) is a manifestation of a hypercoagulable state, most commonly a myeloproliferative disorder (MPD). In the past, HVT was thought to have a poor prognosis unless treated surgically with portosystemic shunt or orthotopic liver transplantation (OLT). The aim of this study was to assess whether early diagnosis of the underlying hematologic disorder and institution of appropriate medical therapy have altered outcome. We reviewed the charts of 22 patients with HVT evaluated at our center from January 1986 to January 1996. The median age was 32 years (range, 14 to 59 years). Underlying etiologies were MPD, 13 (polycythemia vera, 8; essential thrombocythemia, 4; undefined, 1); dysfibrinogenemia, 1; anticardiolipin antibody, 1; oral contraceptive use, 3; and idiopathic, 4. All patients had ascites, hepatomegaly, and/or abdominal pain. Two underwent mesocaval shunting, and 1 had a peritoneal-venous shunt. Seven patients, including 1 with a mesocaval shunt, underwent OLT. The median duration of symptoms before transplantation was 6 months (range, 1.5 to 11 months). Six transplant patients are alive on long-term anticoagulation therapy at a mean post-OLT follow-up of 42 months (range, 2 to 77 months), without recurrence. Of 13 patients treated medically, 10 (77%) are alive at a median follow-up of 40 months (range, 17 months to 14 years 8 months), 1 has died, and 2 have been lost to follow-up. In a majority of patients, symptoms improve with prompt treatment of the underlying hematologic disorder, with a favorable long-term prognosis. Patients with decompensated liver disease can successfully undergo OLT with a low risk of recurrence on long-term oral anticoagulation.

Original languageEnglish (US)
Pages (from-to)423-429+443-445
JournalLiver Transplantation and Surgery
Volume3
Issue number4
StatePublished - Jan 1 1997

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Budd-Chiari Syndrome
Liver Transplantation
Myeloproliferative Disorders
Therapeutics
Surgical Portasystemic Shunt
Essential Thrombocythemia
Recurrence
Anticardiolipin Antibodies
Polycythemia Vera
Hepatomegaly
Lost to Follow-Up
Oral Contraceptives
Ascites
Abdominal Pain
Liver Diseases
Early Diagnosis
Transplantation
Transplants

ASJC Scopus subject areas

  • Surgery
  • Hepatology

Cite this

Min, A. D., Atillasoy, E. O., Schwartz, M. E., Thiim, M., Miller, C. M., Bodenheimer, J., & Langnas, A. N. (1997). Reassessing the role of medical therapy in the management of hepatic vein thrombosis. Liver Transplantation and Surgery, 3(4), 423-429+443-445.

Reassessing the role of medical therapy in the management of hepatic vein thrombosis. / Min, A. D.; Atillasoy, E. O.; Schwartz, M. E.; Thiim, M.; Miller, C. M.; Bodenheimer, Jr; Langnas, A. N.

In: Liver Transplantation and Surgery, Vol. 3, No. 4, 01.01.1997, p. 423-429+443-445.

Research output: Contribution to journalArticle

Min, AD, Atillasoy, EO, Schwartz, ME, Thiim, M, Miller, CM, Bodenheimer, J & Langnas, AN 1997, 'Reassessing the role of medical therapy in the management of hepatic vein thrombosis', Liver Transplantation and Surgery, vol. 3, no. 4, pp. 423-429+443-445.
Min AD, Atillasoy EO, Schwartz ME, Thiim M, Miller CM, Bodenheimer J et al. Reassessing the role of medical therapy in the management of hepatic vein thrombosis. Liver Transplantation and Surgery. 1997 Jan 1;3(4):423-429+443-445.
Min, A. D. ; Atillasoy, E. O. ; Schwartz, M. E. ; Thiim, M. ; Miller, C. M. ; Bodenheimer, Jr ; Langnas, A. N. / Reassessing the role of medical therapy in the management of hepatic vein thrombosis. In: Liver Transplantation and Surgery. 1997 ; Vol. 3, No. 4. pp. 423-429+443-445.
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