Presence of Hepatocellular Carcinoma Does Not Affect Course and Response to Anticoagulation of Bland Portal Vein Thrombosis in Cirrhotic Patients

Figures & data

Table 1 Demographic and Clinical Characteristics of Patients with and without HCC at the Time of PVT Diagnosis

Clinical Characteristics	All Patients N=162	HCC (n=30)	No HCC (n=132)	P value
Age (years) (mean, SD)	57.6 ± 11.4	58.03 ± 10.7	57.5 ± 11.6	0.977
Male gender (n, %)	111 (68.5)	24 (80)	87 (65.9)	0.191
Etiology*
HCV (N;%)	49 (26.8)	12 (40)	33 (25)	0.121
HBV (N;%)	22 (12.1)	2 (6.7)	18 (13.6)	0.371
HCV+HBV (N;%)	8 (4.4)	0	6 (4.5)	0.595
Virus + alcohol (N;%)	14 (7.7)	4 (13.3)	9 (6.8)	0.270
Alcohol (N;%)	51 (28.0)	7 (23.3)	39 (24.1)	0.511
NASH (N%%)	9 (4.9)	2 (6.7)	5 (3.1)	0.617
NASH + alcohol (N;%)	3 (1.6)	1 (3.3)	2 (1.5)	0.343
Autoimmune (N;%)	8 (4.3)	0	8 (6.1)	0.354
Critpogenethic (N;%)	13 (7.1)	2 (6.7)	10 (7.6)	1
Liver function
Child Pugh score (median; range)	7 (5–13)	7 (5–12)	7 (5–13)	0.864
Child-Pugh class
A (N;%)	68 (42) 43	13 (43.3)	55 (41.7)	1
B (N;%)	71 (44)	15 (50)	56 (42.4)	0.542
C (N;%)	23 (14)	2 (6.7)	21 (15.9)	0.254
MELD (median; range)	12 (7–29)	11 (8–22)	12 (7–29)	0.367
Ascites (N;%)	93 (57.4)	18 (60)	75 (56.8)	0.839
Varices (N;%)*	126 (79.2)	20 (66.7)	106 (80.3)	0.142
F1 (N;%)	79 (49.7)	11 (36.7)	71 (53.8)	0.107
F2 (N;%)	35 (22.0)	9 (30)	26 (19.7)	0.225
F3 (N;%)	9 (5.7)	0	9 (6.8)	0.212
Treatment esophageal varices prior PVT (N;%)	50 (28.6)	5 (16.7)	45 (30.9)	0.080
Treatment gastric varices prior PVT (N;%)	3 (1.8)	1 (3.3)	2 (1.5)	0.461
Esophageal bleeding 6 months prior PVT (N;%)	30 (16.5)	1 (3.3)	29 (19.1)	0.017
Laboratory tests
Bilirubin (mg/dL) (mean; SD)	2.4 (2.2)	2.0 (1.3)	2.5 (2.4)	0.010
Platelet count (mean; SD)	95.8 (73.7)	83.9 (44.2)	98.9 (79.5)	0.151
INR (mean; SD)	1.4 (0.5)	1.2 (0.4)	1.4 (0.5)	0.010
Documented infection at PVT diagnosis (N;%)	20 (12.3)	3 (10)	17 (12.9)	1
Bleeding complication during PVT (N;%)	37 (22.8)	4 (13.3)	33 (25)	0.230

Notes: *Data available in 159 patients. The bold font indicates p-values less than 0.05.

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; NASH, non alcoholic steato-hepatitis; INR, international normalized ratio; MELD, model for end-stage liver disease; HCC, hepatocellular carcinoma.

Table 2 Portal Vein Thrombosis and Imaging Characteristics of Patients with PVT

	All Patients N=162	HCC (n=30)	No HCC (n=132)	P value
Diagnosis
Ultrasound (N;%)	116 (71.6)	14 (46.7)	102 (77.3)	0.001
CT (N;%)	40 (24.7)	13 (43.3)	27 (20.4)	0.017
MR (N;%)	6 (3.7)	3 (10)	3 (2.3)	0.078
Portal vein trunk (N;%)	121 (74.7)	24 (80)	97 (73.5)	0.642
Partial (N;%); Total (N;%)	111 (68.5)/10 (6.2)	22 (73.3)/2 (6.7)	89 (67.4)/8 (6.1)	0.760
Intrahepatic branches (N;%)	82 (50.6)	13 (43.3)	69 (52.3)	0.422
Partial (N;%); Total (N;%)	65 (40.1)/17 (10.5)	12 (40)/1 (3.3)	53 (40.1)/16 (12.1)	0.334
Splenic vein (N;%)	22 (13.6)	1 (3.3)	21 (15.9)	0.080
Partial (N;%); Total (N;%)	19 (11.7)/3 (1.8)	1 (3.3)/0	18 (13.6)/3 (2.3)	0.184
Superior mesenteric vein (N;%)	36 (22.2)	11 (36.7)	25 (15.9)	0.050
Partial (N;%); Total (N;%)	31 (19.1)/5 (3.1)	9 (30)/2 (6.7)	22 (16.7)/3 (2.3)	0.091
Cavernoma (N;%)*	20 (12.7)	2 (6.7)	18 (13.6)	0.373
Splenomegaly (N;%)	148 (91.3)	27 (90)	121 (91.7)	0.672
Recanalization at the end of follow-up (N;%)	59 (36.4)	9 (30)	50 (37.9)	0.530
Partial (N;%); Total (N;%)	27 (16.7)/32 (19.7)	3 (10)/6 (20)	24 (18.2)/26 (19.7)	0.543

Note: *Data available in 157 patients.

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.

Table 3 Baseline Characteristics of Patients Who Received Anticoagulation (n=69)

Variable	All Patients (n=69)	HCC (n=13)	No HCC (n=56)	P value
Age (years) (mean, SD)	58.07 ± 11.4	60.23 ± 10.7	56.64 ± 11.4	0.109
Male gender (n, %)	47 (65.5)	11 (80.5)	36 (60.7)	0.238
Etiology*
HCV (N;%)	22 (31.0)	6 (40)	16 (28.6)	0.121
HBV (N;%)	12 (16.9)	2 (6.7)	10 (17.9)	0.105
HCV+HBV (N;%)	1 (1.4)	0	1 (1.8)	0.595
Virus + alcohol (N;%)	5 (7.0)	0 (13.3)	4 (7.1)	0.194
Alcohol (N;%)	13 (18.3)	4 (23.3)	9 (16.1)	0.436
NASH (N%%)	4 (5.6)	2 (6.7)	3 (5.4)	0.228
NASH + alcohol (N;%)	0 (0)	1 (3.3)	0 (0)	0.586
Autoimmune (N;%)	4 (5.6)	0	4 (7.1)	0.034
Critpogenethic (N;%)	6 (8.5)	0	6 (10.7)	0.009
Liver function
Child Pugh score (median; range)	6 (5–13)	7 (5–12)	7 (5–13)	0.330
Child-Pugh class
A (N;%)	30 (48.4) 43	13 (43.3)	27 (48.2)	0.542
B (N;%)	27 (43.5)	15 (50)	24 (42.9)	0.364
C (N;%)	5 (8.1)	2 (6.7)	5 (8.9)	0.290
MELD (median; range)	11 (7–29)	11 (8–22)	11 (7–29)	0.367
Ascites (N;%)	93 (57.4)	18 (60)	29 (51.8)	0.471
Varices (N;%)*	57 (83.1)	11 (66.7)	46 (83.9)	0.817
F1 (N;%)	45 (63.4)	8 (36.7)	37 (66.1)	0.451
F2 (N;%)	9 (14.1)	3 (30)	6 (10.7)	0.328
F3 (N;%)	4 (5.6)	0	3 (7.1)	0.057
Treatment esophageal varices prior PVT (N;%)	22 (31.0)	4 (16.7)	18 (32.1)	0.120
Treatment gastric varices prior PVT (N;%)	0 (0)	0 (0)	0 (0)
Esophageal bleeding 6 months prior PVT (N;%)	9 (14.1)	1 (7.7)	8 (14.3)	0.081
Laboratory tests
Bilirubin (mg/dL) (mean; SD)	1.9 (1.4)	2.0 (1.3)	2.5 (2.4)	0.640
Platelet count (mean; SD)	81.6 (58.7)	83.9 (44.2)	88.6 (60.2)	0.179
INR (mean; SD)	1.3 (0.5)	1.2 (0.4)	1.3 (0.2)	0.014
Documented infection at PVT diagnosis (N;%)	4 (5.6)	0 (0)	4 (7.2)	0.726
Bleeding complication during PVT (N;%)	17 (22.8)	2 (15.4)	15 (26.8)	0.150

Table 4 Treatment Characteristics in Patients with and without HCC at the Time of PVT Diagnosis

	All Patients N=162	HCC (n=30)	No HCC (n=132)	P value
Treatment (N;%)	69 (42.6)	13 (43.3)	56 (42.4)	1
Therapy started at PVT diagnosis (N;%) (N;%)	50 (30.9)	7 (23.3)	43 (32.6)	0.386
Interval onset start therapy
≤ 6 months (N;%)	55 (33.9)	13 (43.3)	42 (31.8)	0.166
7–12 months (N;%)	8 (4.9)	1 (3.3)	7 (5.3)	1
≥ 13 months (N;%)	6 (3.7)	0	6 (4.5)	0.342
Type of treatment
LMWH (N;%)	50 (30.9)	13 (43.3)	37 (28.0)	0.054
VKA (N;%)	10 (6.2)	0	10 (7.5)	0.674
Fondaparinux (N;%)	9 (5.5)	0	9 (6.8)	0.194
Dose
Daily (N;%)	45 (27.8)	7 (23.3)	38 (28.8)	0.217
Twice daily (N;%)	24 (14.8)	6 (23.3)	18 (13.6)	0.128
Therapy duration (months) (mean ±SD)	13.7 ± 14.5	6.5 ± 4.6	15.5 ± 15.6	0.004
Recanalization at the end of follow-up (N;%)	59 (36.4)	9 (30)	50 (37.9)	0.530
Partial (N,%)/Total (N;%)	27 (16.7)/32 (19.7)	3 (10)/6 (20)	24 (18.2)/26 (19.7)	0.543
Recanalization after therapy
3 months (N;%)	20 (12.3)	5 (16.7)	15 (11.4)	0.528
6 months (N;%)	11 (6.8)	1 (3.3)	10 (7.5)	0.450
12 months (N;%)	6 (3.7)	2 (6.7)	4 (3.0)	0.594
Time between start and recanalization (months ± SD)	4.5 ± 3.6	3.6 ± 3.6	4.8 ± 3.6	0.469
Progression PVT during therapy (N;%)	10 (6.2)	0	10 (7.5)	0.110
Progression PVT after therapy (N;%)	24 (14.8)	3 (10)	21 (15.9)	0.109
Beta-blockers during therapy (N;%)	51 (31.5)	10 (30)	41 (31.1)	1
Causes stop therapy
OLT (N;%)	1 (0.6)	0	1 (0.7)	1
Bleeding complications (N;%)	6 (3.7)	1 (3.3)	5 (3.8)	1
Thrombocytopenia (N;%)	3 (1.8)	0	3 (2.3)	1
Other complications (N;%)	1 (0.6)	0	1 (0.7)	1
Not for complications (N;%)	11 (6.8)	2 (6.7)	9 (6.8)	1

Note: The bold font indicates p-values less than 0.05.

Abbreviations: LMWH low molecular weight heparin; VKA vitamin K antagonist; OLT, orthotopic liver transplantation.