Early Anticoagulation Improves the Long-term Prognosis in Patients with Antiphospholipid Syndrome Associated Portal Vein Thrombosis

Hanxiao You¹, Jiuliang Zhao ², Xinping Tian ², Mengtao Li ³ and Xiaofeng Zeng ², ¹Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China (People's Republic), ²Peking Union Medical College Hospital, Beijing, China (People's Republic), ³Dept. of Rheumatology, Peking Union Medical College Hospital (West Campus), Beijing, China, Beijing, China (People's Republic)

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Antiphospholipid antibodies, antiphospholipid syndrome, thrombosis and prognostic factors

Session Information

Date: Sunday, November 10, 2019

Session Title: Antiphospholipid Syndrome Poster

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Portal vein thrombosis (PVT) is a rare and severe clinical phenotype of antiphospholipid syndrome (APS) with a poor prognosis. Anticoagulation therapy is efficient, but is associated with potentially severe side-effects, especially bleeding episodes. The aim of this study was to retrospectively analysis our single center experience on long-term anticoagulation in APS patients presenting a PVT.

Methods: Data of 26 APS patients with PVT from 2012 to 2019 were enrolled. The diagnosis of PVT was made according to the 2009 American College of Liver Diseases (AASLD) criteria. Regular imaging was performed to monitor the outcome of PVT. The hemorrhagic complications and the recurrence of the PVT after anticoagulation withdrawal were also analyzed.

Results: A total of 26 patients with APS-PVT were enrolled, 5 males and 21 females, with an average age of 39±12.65 years, 9 cases (35%) with acute thrombosis, 12 cases (46%) with chronic thrombosis, and 5 cases (19%) with portal vein spongiformity. 14 cases (54%) with portal hypertension, 13 cases (50%) with esophageal varices, 4 cases(15%) with spleen infarction , 6 cases (23%) with gastrointestinal bleeding and 2 cases (8%) with abdominal infection. Triple aPLs positive in 5 cases (19%). 14 cases began anticoagulation therapy immediately after diagnosis of thrombus. 7 patients got thrombus recanalization. 3 patients got recurrence. 5 patients died.

Conclusion: PVT usually had insidious onset with atypical clinical symptoms and easily be misdiagnosed. Early diagnosis and anticoagulation treatment can bring thrombus recanalization thereby significantly improving the prognosis.

Figure 1 Difference of accumulated survival/no adverse events rate between groups receiving immediate effective anticoagulation and not. Adverse events included recurrent thrombosis, liver cirrhosis and severe portal hypertension complications, such as gastrointestinal bleeding and esophagogastric varices. Effective anticoagulation was defined as sufficient anticoagulant therapy for at least 6 months. Not immediate/invalid anticoagulation was defined as no anticoagulation immediately after the thrombus or course of anticoagulant therapy less than 6 months.

Disclosure: H. You, None; J. Zhao, None; X. Tian, None; M. Li, None; X. Zeng, None.

To cite this abstract in AMA style:

You H, Zhao J, Tian X, Li M, Zeng X. Early Anticoagulation Improves the Long-term Prognosis in Patients with Antiphospholipid Syndrome Associated Portal Vein Thrombosis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/early-anticoagulation-improves-the-long-term-prognosis-in-patients-with-antiphospholipid-syndrome-associated-portal-vein-thrombosis/. Accessed September 29, 2022.

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