Successful Treatment of Partial Portal Vein Thrombosis (PVT) with Low Dose Rivaroxaban

Abstract

In a 63-year-old cirrhotic patient, recanalisation of a partial portal vein thrombosis was achieved by a low dose of rivaroxaban (10 mg daily). After anticoagulant therapy was stopped, partial vein thrombosis recurred. Restarting rivaroxaban at a dose of 10 mg led to recanalisation. The patient did not suffer any complications; in particular no bleeding occurred during 8 months of treatment.

Zusammenfassung

Bei einer 63-jährigen Patientin mit Leberzirrhose konnte durch Gabe von niedrig dosiertem Rivaroxaban (10 mg täglich p. o.) eine Auflösung einer partiellen Pfortaderthrombose erzielt werden. Nach Beendigung der Antikoagulation kam es zu einem Wiederauftreten der partiellen Pfortaderthrombose. Wiederum konnte durch 10 mg Rivaroxaban täglich nach 2 Monaten die Thrombose aufgelöst werden. Im Rahmen der Antikoagulation mit 10 mg Rivaroxaban täglich über einen Zeitraum von insgesamt 8 Monaten konnten keine Komplikationen, insbesondere keine Blutungen beobachtet werden.

Schlüsselwörter

Pfortaderthrombose - Antikoagulation - Rivaroxaban

Key words

portal vein thrombosis - anticoagulation - rivaroxaban

• References

• 1 Amitrano L, Guardascione MA, Brancaccio V et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40: 736-741
• 2 Rodriguez-Castro KI, Porte RJ, Nadal E et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation 2012; 94: 1145-1153
• 3 Seijo S, Garcia-Pagan JC. Anticoagulation in cirrhosis: Ready ....set .... wait!. Hepatology 2013; 58: 1175-1176
• 4 Duplantier JG, Dubuisson L, Senant N et al. A role for thrombin in liver fibrosis. Gut 2004; 53: 1682-1687
• 5 Englesbe MJ, Kubus J, Muhammad W et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transplantation 2010; 16: 83-90
• 6 Lisman T, Kamphuisen PW, Northup PG et al. Established and new-generation antithrombotic drugs in patients with cirrhosis – Possibilities and caveats. J Hepatol 2013; 59: 358-366
• 7 Günther R, Fölsch UR. Pfortaderthrombose bei einem Patienten mit erhöhtem F VIII Spiegel und von Willebrand Faktor. Z Gastroenterol 2002; 40: 409-412
• 8 Tripodi A, Primignani M, Chantarangkul V et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology 2009; 137: 2105-2111
• 9 Senzolo M, Sartori M, Rossetto V et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosistemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int 2012; 32: 919-927
• 10 Francoz C, Belghiti J, Vilgrain V et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 2005; 54: 69-697
• 11 Amitrano L, Guardascione MA, Menchise A et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol 2010; 44: 448-451
• 12 DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology 2009; 49: 1729-1764
• 13 Delgado MG, Seijo S, Yepes I et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776-783
• 14 Kubitza D, Roth A, Becka M et al. Effect of hepatic impairment on the pharmacokinetics and pharmacodynamics of a single dose of rivaroxaban – an oral, direct Factor Xa inhibitor. Br J Clin Pharmacol 2013; 76: 89-98
• 15 Melissa MartinezM, Tandra A, Vuppalanchi R. Treatment of acute portal vein thrombosis by nontraditional anticoagulation. Hepatology 2014; 60: 425-426
• 16 Pannach S, Babath J, Beyer-Westendorf J. Successful treatment of acute portal vein thrombosis with rivaroxaban. Thromb Haemost 2013; 110: 626-627
• 17 Bauer KA. Recent progress in anticoagulant therapy: oral direct inhibitors of thrombin and factor Xa. J Thromb Haemost 2011; (Suppl. 01) 12-19
• 18 Weinz C, Schwarz T, Kubitzka D et al. Metabolism and excretion of rivaroxaban, an oral, direct Factor XA inhibitor, in rats, dogs and humans. Drug Metab Dispos 2009; 37: 1056-1064
• 19 Villa E, Camma C, Marietta M et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143: 1253-1260