A prospective, multicentre study in acute non‐cirrhotic, non‐malignant portal vein thrombosis: comparison of medical and interventional treatment
Summary Background To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non‐cirrhotic, non‐malignant portal vein thrombosis (PVT). Methods This prospective, observational study enrolled...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2020-07, Vol.52 (2), p.329-339 |
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| creator | Rössle, Martin Bettinger, Dominik Trebicka, Jonel Klinger, Christoph Praktiknjo, Michael Sturm, Lukas Caca, Karel Mücke, Victoria Therese Radecke, Klaus Engelmann, Cornelius Zipprich, Alexander Heinzow, Hauke Meyer, Carsten Tappe, Ulrich Appenrodt, Beate Schmidt, Arthur Lange, Christian Strassburg, Christian Zeuzem, Stefan Grandt, Daniel Schmidt, Hartmut Moessner, Joachim Berg, Thomas Lammert, Frank Thimme, Robert Schultheiß, Michael |
| description | Summary
Background
To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non‐cirrhotic, non‐malignant portal vein thrombosis (PVT).
Methods
This prospective, observational study enrolled 65 patients with acute ( |
| doi_str_mv | 10.1111/apt.15811 |
| format | Article |
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Background
To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non‐cirrhotic, non‐malignant portal vein thrombosis (PVT).
Methods
This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively.
Results
Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self‐limiting bleeding complications in nine patients, moderate intra‐abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment.
Conclusions
Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.15811</identifier><language>eng</language><publisher>Chichester: Wiley Subscription Services, Inc</publisher><subject>Bleeding ; Gangrene ; Implants ; Intestine ; Medical treatment ; Multivariate analysis ; Occlusion ; Patients ; Peritoneum ; Portal vein ; Response rates ; Surgery ; Thrombolysis ; Thrombosis</subject><ispartof>Alimentary pharmacology & therapeutics, 2020-07, Vol.52 (2), p.329-339</ispartof><rights>2020 The Authors. published byJohn Wiley & Sons Ltd</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3461-ba4fcc184c7c58df7dba48e2f429c9de68a8e3c5eaac35a491ff8e4654215f583</citedby><cites>FETCH-LOGICAL-c3461-ba4fcc184c7c58df7dba48e2f429c9de68a8e3c5eaac35a491ff8e4654215f583</cites><orcidid>0000-0001-7870-5359 ; 0000-0002-7028-3881 ; 0000-0002-1358-9163 ; 0000-0002-8782-8729</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.15811$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.15811$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids></links><search><creatorcontrib>Rössle, Martin</creatorcontrib><creatorcontrib>Bettinger, Dominik</creatorcontrib><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Klinger, Christoph</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Sturm, Lukas</creatorcontrib><creatorcontrib>Caca, Karel</creatorcontrib><creatorcontrib>Mücke, Victoria Therese</creatorcontrib><creatorcontrib>Radecke, Klaus</creatorcontrib><creatorcontrib>Engelmann, Cornelius</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Heinzow, Hauke</creatorcontrib><creatorcontrib>Meyer, Carsten</creatorcontrib><creatorcontrib>Tappe, Ulrich</creatorcontrib><creatorcontrib>Appenrodt, Beate</creatorcontrib><creatorcontrib>Schmidt, Arthur</creatorcontrib><creatorcontrib>Lange, Christian</creatorcontrib><creatorcontrib>Strassburg, Christian</creatorcontrib><creatorcontrib>Zeuzem, Stefan</creatorcontrib><creatorcontrib>Grandt, Daniel</creatorcontrib><creatorcontrib>Schmidt, Hartmut</creatorcontrib><creatorcontrib>Moessner, Joachim</creatorcontrib><creatorcontrib>Berg, Thomas</creatorcontrib><creatorcontrib>Lammert, Frank</creatorcontrib><creatorcontrib>Thimme, Robert</creatorcontrib><creatorcontrib>Schultheiß, Michael</creatorcontrib><title>A prospective, multicentre study in acute non‐cirrhotic, non‐malignant portal vein thrombosis: comparison of medical and interventional treatment</title><title>Alimentary pharmacology & therapeutics</title><description>Summary
Background
To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non‐cirrhotic, non‐malignant portal vein thrombosis (PVT).
Methods
This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively.
Results
Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self‐limiting bleeding complications in nine patients, moderate intra‐abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment.
Conclusions
Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.</description><subject>Bleeding</subject><subject>Gangrene</subject><subject>Implants</subject><subject>Intestine</subject><subject>Medical treatment</subject><subject>Multivariate analysis</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Peritoneum</subject><subject>Portal vein</subject><subject>Response rates</subject><subject>Surgery</subject><subject>Thrombolysis</subject><subject>Thrombosis</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kc9O3DAQxi1EJRbaA29giQuVCNiOnXh7WyFoKyG1B3qOjDMGo8QOtrNobzwCl74gT9KB5YTUuYzm02_-aD5CDjk75RhnZiqnXGnOd8iC142qBKubXbJgollWQvN6j-znfM8Ya1omFuTvik4p5gls8Ws4oeM8FG8hlAQ0l7nfUB-osXMBGmJ4eXq2PqW7iMzJuzCawd8GEwqdYipmoGvAlnKX4ngTs8_fqI3jZJLPMdDo6Ai9t4iZ0OPsAmmN23wMKOFSU0YsP5NPzgwZvrznA_Ln8uL6_Ed19ev7z_PVVWVr2fDqxkhnLdfStlbp3rU9KhqEk2Jplz002miorQJjbK2MXHLnNMhGScGVU7o-IMfbufiDhxly6UafLQyDCRDn3AnJWcukbgWiRx_Q-zgnvPqNattaKyGR-rqlLD41J3DdlPxo0qbjrHs1qEODujeDkD3bso9-gM3_wW71-3rb8Q8KcJgP</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Rössle, Martin</creator><creator>Bettinger, Dominik</creator><creator>Trebicka, Jonel</creator><creator>Klinger, Christoph</creator><creator>Praktiknjo, Michael</creator><creator>Sturm, Lukas</creator><creator>Caca, Karel</creator><creator>Mücke, Victoria Therese</creator><creator>Radecke, Klaus</creator><creator>Engelmann, Cornelius</creator><creator>Zipprich, Alexander</creator><creator>Heinzow, Hauke</creator><creator>Meyer, Carsten</creator><creator>Tappe, Ulrich</creator><creator>Appenrodt, Beate</creator><creator>Schmidt, Arthur</creator><creator>Lange, Christian</creator><creator>Strassburg, Christian</creator><creator>Zeuzem, Stefan</creator><creator>Grandt, Daniel</creator><creator>Schmidt, Hartmut</creator><creator>Moessner, Joachim</creator><creator>Berg, Thomas</creator><creator>Lammert, Frank</creator><creator>Thimme, Robert</creator><creator>Schultheiß, Michael</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7870-5359</orcidid><orcidid>https://orcid.org/0000-0002-7028-3881</orcidid><orcidid>https://orcid.org/0000-0002-1358-9163</orcidid><orcidid>https://orcid.org/0000-0002-8782-8729</orcidid></search><sort><creationdate>202007</creationdate><title>A prospective, multicentre study in acute non‐cirrhotic, non‐malignant portal vein thrombosis: comparison of medical and interventional treatment</title><author>Rössle, Martin ; Bettinger, Dominik ; Trebicka, Jonel ; Klinger, Christoph ; Praktiknjo, Michael ; Sturm, Lukas ; Caca, Karel ; Mücke, Victoria Therese ; Radecke, Klaus ; Engelmann, Cornelius ; Zipprich, Alexander ; Heinzow, Hauke ; Meyer, Carsten ; Tappe, Ulrich ; Appenrodt, Beate ; Schmidt, Arthur ; Lange, Christian ; Strassburg, Christian ; Zeuzem, Stefan ; Grandt, Daniel ; Schmidt, Hartmut ; Moessner, Joachim ; Berg, Thomas ; Lammert, Frank ; Thimme, Robert ; Schultheiß, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3461-ba4fcc184c7c58df7dba48e2f429c9de68a8e3c5eaac35a491ff8e4654215f583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bleeding</topic><topic>Gangrene</topic><topic>Implants</topic><topic>Intestine</topic><topic>Medical treatment</topic><topic>Multivariate analysis</topic><topic>Occlusion</topic><topic>Patients</topic><topic>Peritoneum</topic><topic>Portal vein</topic><topic>Response rates</topic><topic>Surgery</topic><topic>Thrombolysis</topic><topic>Thrombosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rössle, Martin</creatorcontrib><creatorcontrib>Bettinger, Dominik</creatorcontrib><creatorcontrib>Trebicka, Jonel</creatorcontrib><creatorcontrib>Klinger, Christoph</creatorcontrib><creatorcontrib>Praktiknjo, Michael</creatorcontrib><creatorcontrib>Sturm, Lukas</creatorcontrib><creatorcontrib>Caca, Karel</creatorcontrib><creatorcontrib>Mücke, Victoria Therese</creatorcontrib><creatorcontrib>Radecke, Klaus</creatorcontrib><creatorcontrib>Engelmann, Cornelius</creatorcontrib><creatorcontrib>Zipprich, Alexander</creatorcontrib><creatorcontrib>Heinzow, Hauke</creatorcontrib><creatorcontrib>Meyer, Carsten</creatorcontrib><creatorcontrib>Tappe, Ulrich</creatorcontrib><creatorcontrib>Appenrodt, Beate</creatorcontrib><creatorcontrib>Schmidt, Arthur</creatorcontrib><creatorcontrib>Lange, Christian</creatorcontrib><creatorcontrib>Strassburg, Christian</creatorcontrib><creatorcontrib>Zeuzem, Stefan</creatorcontrib><creatorcontrib>Grandt, Daniel</creatorcontrib><creatorcontrib>Schmidt, Hartmut</creatorcontrib><creatorcontrib>Moessner, Joachim</creatorcontrib><creatorcontrib>Berg, Thomas</creatorcontrib><creatorcontrib>Lammert, Frank</creatorcontrib><creatorcontrib>Thimme, Robert</creatorcontrib><creatorcontrib>Schultheiß, Michael</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rössle, Martin</au><au>Bettinger, Dominik</au><au>Trebicka, Jonel</au><au>Klinger, Christoph</au><au>Praktiknjo, Michael</au><au>Sturm, Lukas</au><au>Caca, Karel</au><au>Mücke, Victoria Therese</au><au>Radecke, Klaus</au><au>Engelmann, Cornelius</au><au>Zipprich, Alexander</au><au>Heinzow, Hauke</au><au>Meyer, Carsten</au><au>Tappe, Ulrich</au><au>Appenrodt, Beate</au><au>Schmidt, Arthur</au><au>Lange, Christian</au><au>Strassburg, Christian</au><au>Zeuzem, Stefan</au><au>Grandt, Daniel</au><au>Schmidt, Hartmut</au><au>Moessner, Joachim</au><au>Berg, Thomas</au><au>Lammert, Frank</au><au>Thimme, Robert</au><au>Schultheiß, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective, multicentre study in acute non‐cirrhotic, non‐malignant portal vein thrombosis: comparison of medical and interventional treatment</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><date>2020-07</date><risdate>2020</risdate><volume>52</volume><issue>2</issue><spage>329</spage><epage>339</epage><pages>329-339</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non‐cirrhotic, non‐malignant portal vein thrombosis (PVT).
Methods
This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively.
Results
Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self‐limiting bleeding complications in nine patients, moderate intra‐abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment.
Conclusions
Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.</abstract><cop>Chichester</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1111/apt.15811</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7870-5359</orcidid><orcidid>https://orcid.org/0000-0002-7028-3881</orcidid><orcidid>https://orcid.org/0000-0002-1358-9163</orcidid><orcidid>https://orcid.org/0000-0002-8782-8729</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Alimentary pharmacology & therapeutics, 2020-07, Vol.52 (2), p.329-339 |
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| source | Wiley Free Content; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Bleeding Gangrene Implants Intestine Medical treatment Multivariate analysis Occlusion Patients Peritoneum Portal vein Response rates Surgery Thrombolysis Thrombosis |
| title | A prospective, multicentre study in acute non‐cirrhotic, non‐malignant portal vein thrombosis: comparison of medical and interventional treatment |
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