The use of nonselective beta blockers is a risk factor for portal vein thrombosis in cirrhotic patients
Rosa Zampino1, Rita Lebano1, Nicola Coppola2, Margherita Macera2, Anna Grandone3, Luca Rinaldi1, Ilario De Sio4, Antonella Tufano5, Gianfranca Stornaiuolo2, Luigi E Adinolfi1, Emanuele Durante-Mangoni4, Gaeta G Battista2, Alferio Niglio4
1 Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Infectious Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
2 Department of Public Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
3 Department of Pediatrics, University of Campania “Luigi Vanvitelli”, Naples, Italy
4 Department of Clinical and Experimental Medicine and Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
5 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
Dr. Rosa Zampino
Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Unit of Infectious and Transplant Medicine A.O.R.N. dei Colli - Ospedale Monaldi, Via Ettore Ruggieri, Naples
Source of Support: None, Conflict of Interest: None
Background/Aim: A reduction in portal vein inflow velocity seems to predispose to the emergence of portal vein thrombosis (PVT). Nonselective β-blockers (NSBBs), used to prevent variceal bleeding, may increase the development of PVT by reducing portal vein inflow velocity. In this retrospective case-control study, we evaluated the risk factors and clinical features of a first event of PVT in 130 cirrhotics, 19 (15%) with (PVT group) and 111 (85%) without PVT (non-PVT group).
Patients and Methods: Patient evaluation and NNBB treatment were carried out according to the AASLD guidelines.
Results: PVT was prevalently partial (84%) and asymptomatic (84%). Patients with PVT were treated with different regimens, and resolution of thrombosis was observed in about 50% of the cases. In both groups, HCV was the most frequent cause of cirrhosis and Child-Pugh score A was prevalent. Ascites and esophageal varices were more frequent in the PVT group (P = 0.05 and <0.000, respectively). Treatment with NSBBs was significantly more frequent in the PVT group than in the non-PVT group (P < 0.000). PVT was associated with higher prevalence of chronic renal disease (P = 0.002), higher PT impairment (P = 0.003) and lower AST and ALT (P = 0.000). At multivariate logistic regression analysis, history of esophageal varices (P = 0.007) and NSBB treatment (P = 0.0003) were independent risk factors significantly associated with PVT.
Conclusions: Esophageal varices and NSBB treatment were independent risk factors of PVT. Larger studies should evaluate the risk between variceal bleeding and portal vein thrombosis of using NSBBs, particularly in the prevention of first bleeding in nonadvanced liver cirrhosis.