Cause of portal or hepatic venous thrombosis in adults: The role of multiple concurrent factors

✍ Scribed by Marie-Hélène Denninger; Yasmine Chaït; Nicole Casadevall; Sophie Hillaire; Marie-Claude Guillin; Annie Bezeaud; Serge Erlinger; Jean Briere; Dominique Valla

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 58 KB
• Volume: 31
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510310307

✦ Synopsis

According to a recent hypothesis, venous thrombosis results from the concurrence of several factors. This hypothesis was assessed in patients with portal or hepatic venous thrombosis by simultaneously investigating most of the currently identified prothrombotic disorders, local precipitating factors, and other risk factors such as oral contraceptive use. Patients with a tumorous obstruction and patients with cirrhosis with portal vein thrombosis were excluded. The prothrombotic disorders that were investigated included classical and occult myeloproliferative disorders; antiphospholipid syndrome; protein C; protein S and antithrombin deficiency; factor V Leiden; factor II; and methylene-tetrahydrofolate-reductase gene mutations. We found 1 or several prothrombotic disorders and a local precipitating factor in 26 and 10 of the 36 patients with portal vein thrombosis, respectively; and in 28 and none of the 32 patients with hepatic vein thrombosis, respectively. We found a combination of prothrombotic disorders in 5 and 9 patients with portal and hepatic vein thrombosis, respectively, whereas such a combination is expected in less than 1% of asymptomatic subjects. Of the 10 patients with a local precipitating factor, 8 had a prothrombotic disorder. Of the 13 patients who use oral contraceptives, 10 had a prothrombotic disorder. We conclude that portal or hepatic venous thrombosis should be regarded as an index for 1 or several prothrombotic disorders, whether or not local precipitating factors or oral contraceptive use are found. Concurrence of prothrombotic disorders is more common than expected. Extensive investigation of prothrombotic disorders and anticoagulation should be considered in patients with portal or hepatic venous thrombosis. (HEPATOLOGY 2000;31: 587-591.)

According to a recent concept, venous thrombosis would result from the convergence of an inherited predisposition, owing to a mutation in 1 or more genes, and an acquired thrombogenic stimulus. 1 However, this concept has not been evaluated in the setting of hepatic or portal venous thrombosis. This concept, if validated, would be of major consequence for the investigation and treatment of patients. Portal or hepatic venous thromboses have been commonly found to be associated with acquired prothrombotic disorders 2-7 but inherited disorders have not been extensively investigated. Therefore, the study reported here was undertaken to ascertain the prevalence of newly recognized inherited prothrombotic disorders in patients with hepatic or portal vein thrombosis, 8-10 and also to assess to what extent inherited as well as acquired prothrombotic disorders, local precipitating factors, and other risk factors for thrombosis concur to the development of hepatic or portal venous thrombosis.