1. Background
2. Methods
3. Results
3.1 Incidence of PVT and other abdominal vein thrombosis
Thrombosis classified based on ICD-10 codes | No. of cases (%) |
---|---|
Portal vein thrombosis (I81) | 194 (41.5) |
Mesenteric vein thrombosis (K55.0) | 18 (3.9) |
Thrombosis of vena cava (I82.2) | 81 (17.3) |
Thrombosis of renal vein (I82.3) | 18 (3.9) |
Thrombosis of other specified vein (I82.8) | 96 (20.6) |
Thrombosis of unspecified vein (I82.9) Thrombosis of isolated splenic vein | 52 (11.1) 3 (0.6) |
Thrombosis of vena cava + renal vein | 3 (0.6) |
Thrombosis of vena cava + other specified veins | 1 (0.2) |
Thrombosis of vena cava + renal vein + other specified veins | 1 (0.2) |
Total cases in this study
|
467 (100)
|
Site of thrombotic involvement#
| No. of cases (%) |
---|---|
Portal vein only | 145 (74.7) |
Porto-mesenteric (SMV) | 12 (6.2) |
Porto-mesenteric (IMV) | 0 (0) |
Porto-venacaval | 2 (1) |
Porto-splenic | 16 (8.2) |
Porto-spleno-mesenteric (SMV) | 19 (9.8) |
Porto-spleno-mesenteric (IMV) | 1 (0.5) |
3.2 Clinical presentations of patients with PVT
Sex (M:F)
| 126:68 |
Mean age ± SD (range)
| 50.2 ± 17.9 (0.2-82.9) |
- Male | (n = 126) 52.4 ± 15.7 (1-80.8) |
- Female | (n = 68) 46.2 ± 20.8 (0.2-82.9) |
Age <20 (no. of cases, %)
| 13 (6.7) |
Age 20-39 (no. of cases, %)
| 36 (18.6) |
Age 40-60 (no. of cases, %)
| 81 (41.8) |
Age >60 (no. of cases, %)
| 64 (33) |
Clinical presentations
|
No. of cases (%)
|
Asymptomatic
| 2 (1) |
Abdominal distension/ascites
| 134 (69.1) |
Abdominal pain
| 98 (50.5) |
Jaundice
| 70 (36.1) |
Fever
| 26 (13.4) |
Splenomegaly
| 106 (54.6) |
Hemorrhage
| 35 (18)* |
Loss of appetite
| 56 (28.9) |
Weight loss
| 63 (32.5) |
Nausea
| 32 (16.5) |
Vomiting
| 25 (12.9) |
Diarrhea
| 14 (7.2) |
3.3 Risk factors associated with PVT
Malignancy | 126 (65) |
HCC (102), CCA (16), pancreatic CA (3), gallbladder CA (1), hepatoblastoma (1), ovarian CA (1), secondary malignant neoplasm of liver (2) | |
Cirrhosis*
|
98 (50.5)
|
HBV (38), HCV (12), Alcohol (15), HBV+HCV (2), HBV+alcohol (8), HCV+alcohol (3), cryptogenic (19), autoimmune (1) [Child-Pugh Class: A (29), B (30), C (30), unknown (9)] | |
Abdominal intervention
|
15 (7.7)
|
Umbilical catheterization (5), splenectomy (2), cholecystectomy (5), hepatectomy (1), percutaneous transhepatic biliary drainage (PTBD) (1), Whipple operation with revised hepatojejunostomy and T-tube (1) | |
Abdominal inflammation/infection
|
18 (9.3)
|
Pancreatitis (3), liver abscess (4), cholangitis (4), splenic abscess (1), cholecystitis (1), omphalitis (1), abdominal tuberculosis (1), sepsis (3) | |
Bone marrow (BM) disorders
|
9 (4.6)
|
Polycythemia vera (3), primary myelofibrosis (2), essential thrombocytosis (1), paroxysmal nocturnal hemoglobinuria (2), acute myeloid leukemia (1) | |
Hereditary coagulation defects
|
1 (0.5)
|
Protein S deficiency (1) | |
Anti-phospholipid syndrome
|
1 (0.5)
|
Oral contraceptive pills
|
4 (2)
|
Others
**
|
2 (1)
|
Idiopathic causes
|
18 (9.3)
|
Risk factors* | All patients | Age range (years) | Gender | ||||
---|---|---|---|---|---|---|---|
<20 | 20-39 | 40-60 | >60 | Male | Female | ||
N (%) 194 (100) | N (%) 13 (6.7) | N (%) 36 (18.6) | N (%) 81 (41.8) | N (%) 64 (33) | N (%) 126 (65) | N (%) 68 (35.1) | |
Cirrhosis
| 98 (50.5) | 1 (7.7) | 6 (16.7) | 52 (64.2) | 39 (60.9) | 78 (61.9) | 20 (29.4) |
Malignancy
| 126 (65) | 1 (7.7) | 14 (38.9) | 56 (69.1) | 55 (86) | 94 (74.6) | 32 (47.1) |
Abdominal intervention
| 15 (7.7) | 4 (30.8) | 3 (8.3) | 6 (7.4) | 2 (3.1) | 6 (4.8) | 9 (13.2) |
Abdominal inflammation or infection
| 18 (9.3) | 1 (7.7) | 5 (13.9) | 7 (8.6) | 5 (7.8) | 7 (5.6) | 8 (11.8) |
BM disorders, protein S deficiency, and APS
| 11 (5.7) | 1 (7.7) | 3 (8.3) | 5 (6.2) | 2 (3.1) | 5 (4) | 6 (8.8) |
Oral contraceptive pills
| 4 (2) | 0 (0) | 4 (11.1) | 0 (0) | 0 (0) | 0 (0) | 4 (5.9) |
Others
| 2 (1) | 0 (0) | 2 (5.6) | 0 (0) | 0 (0) | 1 (0.8) | 1 (1.5) |
Idiopathic
| 18 (9.3) | 6 (46.2) | 8 (22.2) | 3 (3.7) | 1 (1.6) | 7 (5.6) | 11 (16.2) |
3.4 Incidence of HBV and HCV infection in patients with PVT
Risk factors* | PVT with HCC or cirrhosis | PVT without HCC and cirrhosis | Age (years) | Gender | ||||
---|---|---|---|---|---|---|---|---|
<20 | 20-39 | 40-60 | >60 | Male | Female | |||
N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | |
HBV infection
a
| 51 (42.1) | 2 (2.7) | 0 (0) | 9 (0.25) | 27 (33.3) | 17 (26.6) | 49 (39) | 4 (5.9) |
HCV infection
b
| 17 (14) | 1 (1.4) | 0 (0) | 0 (0) | 13 (16) | 5 (7.8) | 12 (9.5) | 6 (8.8) |
HBV and HCV co-infection
c
| 2 (1.7) | 0 (0) | 0 (0) | 0 (0) | 2 (2.5) | 0 (0) | 2 (1.6) | 0 (0) |
3.5 Distribution of thrombus in PVT patients with or without cirrhosis and cancer
Total | Right Branch N (%) 112 (61.9) | Left branch N (%) 82 (45.3) | Main N (%) 116 (64.1) | Confluence N (%) 10 (5.5) | |
---|---|---|---|---|---|
Age (years)
| |||||
<20 | 10 | 4 (40) | 2 (20) | 7 (70) | 0 (0) |
20-39 | 34 | 17 (50) | 12 (35.3) | 27 (79.4) | 1 (2.9) |
40-60 | 75 | 47 (62.7) | 41 (54.7) | 43 (57.3) | 5 (6.7) |
>60 | 62 | 44 (71) | 27 (43.5) | 39 (62.9) | 4 (6.5) |
Gender
| |||||
-Male | 122 | 80 (65.6) | 57 (46.7) | 79 (64.8) | 7 (5.7) |
-Female | 59 | 32 (54.2) | 25 (42.4) | 37 (62.7) | 3 (5.2) |
PVT with CA or cirrhosis
| |||||
-CA only -Cirrhosis only | 44 15 | 32 (72.7) 9 (60) | 17 (38.6) 5 (33.3) | 26 (59.1) 13 (86.7) | 1 (2.3) 0 (0) |
-CA with cirrhosis | 80 | 52 (65) | 43 (53.8) | 43 (53.8) | 5 (6.3) |
PVT without CA and cirrhosis
| |||||
-BM disorders and other risks | 8 | 6 (75) | 7 (87.5) | 6 (75) | 1 (12.5) |
-Others | 34 | 13 (38.2) | 10 (29.4) | 28 (82.4) | 3 (8.8) |