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Thromb Haemost 1999; 81(05): 711-714
DOI: 10.1055/s-0037-1614559
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Clotting Activation after Transjugular Intrahepatic Portosystemic Stent Shunt

Stefania Basili
2   Dipartimento di Terapia Medica
,
Merli Manuela
3   Cattedra di Gastroenterologia, Università »La Sapienza«, Rome, Italy
,
Domenico Ferro
1   From the Istituto I Clinica Medica
,
Raffaella Lionetti
3   Cattedra di Gastroenterologia, Università »La Sapienza«, Rome, Italy
,
Elisabetta Rossi
1   From the Istituto I Clinica Medica
,
Oliviero Riggio
3   Cattedra di Gastroenterologia, Università »La Sapienza«, Rome, Italy
,
Valentina Valeriano
3   Cattedra di Gastroenterologia, Università »La Sapienza«, Rome, Italy
,
Livio Capocaccia
3   Cattedra di Gastroenterologia, Università »La Sapienza«, Rome, Italy
,
Francesco Violi
1   From the Istituto I Clinica Medica
› Author Affiliations
Further Information

Publication History

Received 15 December 1998

Accepted after revision 25 January 1999

Publication Date:
09 December 2017 (online)

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Summary

Background and Aim. Aim of the study was to investigate the behaviour of clotting system in peripheral circulation of cirrhotic patients undergoing transjugular intrahepatic portosystemic stent shunt (TIPS). Methods. Clotting variables and endotoxemia were measured 48 h and 30 days after TIPS in patients randomised to receive heparin or not. Results. Forty-eight hours after TIPS, a significant increase of prothrombin fragment F1+2 was observed; such increase was less evident in patients given heparin. Similar findings were observed for endotoxemia, which, however, was not affected by heparin treatment. Thirty days after TIPS procedure prothrombin fragment F1+2 and endotoxemia returned to baseline values independently of the treatment given. Conclusion. This study shows that TIPS is associated with an increase of clotting activation which might contribute to acute thrombosis observed after this procedure.

 

  • References

  • 1 Rössle M, Haag K, Ochs A, Sellinger M, Nöldge G, Perarnau JM, Berger E, Blum V, Gabelmann A, Havenstein KH, Langer M, Gerok W. The trans-jugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding.. N Eng J Med 1994; 330: 165-71.
    CrossrefPubMedSearch in Google Scholar
  • 2 Ochs A, Rössle M, Haag K, Hauenstein KH, Deibert P, Siegerstetter V, Huonker M, Langer M, Blum HE. The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites.. N Engl J Med 1995; 332: 1192-7.
    CrossrefPubMedSearch in Google Scholar
  • 3 Bataller R, Arroyo V, Gines P. Management of ascites in cirrhosis.. J Gastroenterol Hepatol 1997; 12: 723-33.
    CrossrefPubMedSearch in Google Scholar
  • 4 Marshall JB, King PD. Transjugular intrahepatic portosystemic shunt or sclerotherapy: which would you choose?. Ann Intern Med 1998; 128: 321-2.
    PubMedSearch in Google Scholar
  • 5 Stanley AJ, Hayes PC. Portal hypertension and variceal haemorrhage.. Lancet 1997; 350: 1235-9.
    CrossrefPubMedSearch in Google Scholar
  • 6 Lind CD, Malisch TW, Chong WK, Richard WO, Pinson CW, Meranze SG, Mazer M. Incidence of shunt occlusion or stenosis following trans-jugular intrahepatic portosystemic shunt placement.. Gatroenterology 1994; 106: 1277-83.
    CrossrefPubMedSearch in Google Scholar
  • 7 Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review.. Radiographics 1993; 13: 1185-210.
    CrossrefPubMedSearch in Google Scholar
  • 8 Sanyal AJ, Freedman AM, Luketic VA, Purdum PP, Shiffman ML, De-Meo J, Cole PE, Tisnado J. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts.. Gastroenterology 3rd 1997; 112: 889-98.
    CrossrefPubMedSearch in Google Scholar
  • 9 Shiffman ML, Cole PE. Complications of implantation. In Conn HO, Palmaz J, Rosch J, Rossle M. Eds. TIPS: Transjugular Intrahepatic Porto-Systemic Stent-Shunts.. New York: Igaku-Shoin Medical Publishers; 1996: 249-66.
    Search in Google Scholar
  • 10 Saxon RR, Barton RE, Keller FS, Rosch J. Stenosis and occlusion after TIPS: prevention and correction. In Conn HO, Palmaz J, Rosch J, Rossle M. Eds. TIPS: Transjugular Intrahepatic Porto-Systemic Stent-Shunts.. New York: Igaku-Shoin Medical Publishers; 1996: 267-80.
    Search in Google Scholar
  • 11 LaBerge JM, Ferrell LD, Ring EJ, Gordon RL, Lake JR, Roberts JP, Ascher NL. Histopathologic study of transjugular intrahepatic portosystemic shunts.. J Vasc Interv Radiol 1991; 2: 549-56.
    CrossrefPubMedSearch in Google Scholar
  • 12 LaBerge JM, Ferrell LD, Ring EJ, Gordon RL. Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts.. J Vasc Interv Radiol 1993; 4 (06) 779-86.
    CrossrefPubMedSearch in Google Scholar
  • 13 Saxon RR, Timmermans HA, Uchida BT, Petersen BD, Benner KG, Rabkin J, Keller FS. Stent-grafts for revision of TIPS stenoses and occlusions: a clinical pilot study.. J Vasc Interv Radiol 1997; 8: 539-48.
    CrossrefPubMedSearch in Google Scholar
  • 14 Sauer P, Theilmann L, Herrmann S, Bruckner T, Roeren T, Richter G, Stremmel W, Stiehl A. Phenprocoumon for prevention of shunt occlusion after transjugular intrahepatic portosystemic stent shunt: a randomized trial.. Hepatology 1996; 24: 1433-6.
    PubMedSearch in Google Scholar
  • 15 Shiffman ML. Can anticoagulation enhance TIPS patency?. Hepatology 1996; 24: 1533-5.
    CrossrefPubMedSearch in Google Scholar
  • 16 Pugh RNH, Murray-Lyon IM, Dawson JL. Transection of oesophagus for bleeding oesophagus varices.. Br J Surg 1973; 60: 646-9.
    CrossrefPubMedSearch in Google Scholar
  • 17 Merli M, Salerno F, Riggio O, De Franchis R, Fiaccadori F, Meddi P, Primignani M, Pedretti G, Maggi A, Capocaccia L, Lovaria A, Ugolotti U, Salvatori F, Bezzi M, Rossi P. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal bleeding in cirrhosis: a randomized multicenter trial. Gruppo Italiano Studio TIPS (G.I.S.T.).. Hepatology 1998; 27: 48-53.
    CrossrefPubMedSearch in Google Scholar
  • 18 Violi F, Ferro D, Basili S, Saliola M, Quintarelli C, Alessandri C, Cordova C. Association between low-grade disseminated intravascular coagulation and endotoxemia in patients with liver cirrhosis.. Gastroenterology 1995; 109: 531-9.
    CrossrefPubMedSearch in Google Scholar
  • 19 Armitage P, Berry G. Statistical methods in medical research. 2nd ed.. Blackwell scientific Publication; Oxford (UK): 1990. pp 200-15.
    Search in Google Scholar
  • 20 Semeraro N, Biondi A, Lorenzet R, Locati D, Mantovani A, Donati MB. Direct induction of tissue factor synthesis by endotoxin in human macrophages from diverse anatomical sites.. Immunology 1983; 50: 529-35.
    PubMedSearch in Google Scholar
  • 21 Van Deventer SJH, Buller HR, Ten Cate JW, Aarden LA, Hack Ce, Sturk A. Experimental endotoxemia in human: analysis of cytokine release and coagulation fibrinolytic and complement pathways.. Blood 1990; 12: 2520-6.
    PubMedSearch in Google Scholar
  • 22 Violi F, Ferro D, Basili S, Lionetti R, Rossi E, Merli M, Riggio O, Bezzi M, Capocaccia L. Ongoing prothrombotic state in the portal circulation of cirrhotic patients.. Thromb Haemost 1997; 77: 44-7.
    Thieme ConnectPubMedSearch in Google Scholar