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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Philippe SOGNI
Coup de coeur :
 
 
Hepatology
  2015/02  
 
  2015 Feb;61(2):660-7  
  doi: 10.1002/hep.27546  
 
  Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: Results of a longitudinal study  
 
  Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou PE, Plessier A, Roulot D, Chaffaut C, Bourcier V, Trinchet JC, Valla DC; Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire  
  http://onlinelibrary.wiley.com/doi/10.1002/hep.27546/abstract  
 
 

Abstract
In cirrhosis, portal vein thrombosis (PVT) could be a cause or a consequence of the progression of liver disease. We analyzed data from a prospective trial of ultrasound screening for hepatocellular carcinoma in order to identify risk factors for and the impact of PVT in patients with cirrhosis. In all, 1,243 adults with cirrhosis without PVT were enrolled from 43 liver units in France and Belgium between June 2000 and March 2006. The mean follow-up was 47 months. Doppler ultrasonography was used to check the portal vein. Progression of liver disease was defined by the development of: ascites, hepatic encephalopathy, variceal bleeding, prothrombin <45%, serum bilirubin >45 μmol/L, albumin <28 g/L, and/or creatinine >115 μmol/L. G20210A prothrombin and factor V gene mutations were assessed in sera stored at three large centers. The 5-year cumulative incidence of PVT was 10.7%. PVT was mostly partial and varied over time. The development of PVT was independently associated with baseline esophageal varices (P = 0.01) and prothrombin time (P = 0.002), but not with disease progression before PVT, or prothrombotic mutations. Disease progression was independently associated with baseline age (hazard ratio [HR] 1.55; 95% confidence interval [CI]: 1.11-2.17), body mass index (HR 1.40; 95% CI: 1.01-1.95), prothrombin time (HR 0.79; 95% CI: 0.70-0.90), serum albumin (HR 0.97; 95% CI: 0.94-0.99), and esophageal varices (HR 1.70; 95% CI: 1.21-2.38) but not with the prior development of PVT (HR 1.32; 95% CI: 0.68-2.65).

Conclusion
In patients with cirrhosis, the development of PVT is associated with the severity of liver disease at baseline, but does not follow a recent progression of liver disease. There is no evidence that the development of PVT is responsible for further progression of liver disease.

 
Question posée
 
La thrombose porte non tumorale au cours de la cirrhose est-elle un facteur d’aggravation de la maladie hépatique ?
 
Question posée
 
La thrombose porte non tumorale au cours de la cirrhose est associée à la gravité de la maladie hépatique mais n’est pas en soi un facteur d’aggravation.
 
Commentaires

Remet en cause l’idée de l’anticoagulation curative de la thrombose porte non tumorale au cours de la cirrhose à la suite entre autre de l’article de Villa E et al. Gastroenterology 2012; 143: 1253-60. Discussion en revanche de l’intérêt d’une anticoagulation préventive pour l’instant non démontrée. De même, il peut être important de prendre en compte le sur-risque de la transplantation hépatique en cas de thrombose porte étendue.

 
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