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Original research article


Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count.

W E SaadW BleibelN AdenawC E WagnerC AndersonJ F AngleA M Al-OsaimiM G DaviesS Caldwell
Departments of Radiology, Surgery and Medicine, University of Virginia, Virginia, Department of Surgery, Methodist Hospital, Cornell-Weiel School of Medicine, Houston, Texas, Department of Internal Medicine, Owensboro Health Gastroenterology and Hepatology, Kentucky, United States
Date of Submission: 21-Nov-2013, Date of Acceptance: 26-Mar-2013, Date of Web Publication: 30-Apr-2014.
Corresponding Author:
Corresponding Author

Wael EA Saad

Director of Vascular and Interventional Radiology, Cardiovascular Center, RM 5588, 1500 East Medical Center Drive, Ann Arbor, Michigan-48109, US.
E-mail: wsaad@umich.edu

Corresponding Author:
Corresponding Author

Wael EA Saad

Director of Vascular and Interventional Radiology, Cardiovascular Center, RM 5588, 1500 East Medical Center Drive, Ann Arbor, Michigan-48109, US.
E-mail: wsaad@umich.edu

DOI: 10.4103/2156-7514.131743 Facebook Twitter Google Linkedin

ABSTRACT



Objectives: Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO) have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included), and to assess the effect of BRTO on platelet count over a 1-year period.
Materials and Methods: This is a retrospective review of 35 patients who underwent BRTO (March 2008–August 2011). Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma) were analyzed (multivariate analysis). A total of 91% (n = 32/35) of patients had thrombocytopenia (<150,000 platelet/cm3 ) pre-BRTO. Platelet counts at within 48-h, within 2 weeks and at 30-60 days intervals (up to 6 months) after BRTO were compared with the baseline pre-BRTO values.
Results: 35 Patients with adequate platelet follow-up were found. A total of 92% and 17% of patients had a platelet count of <150,000/cm3 and <50,000/cm3,respectively. There was a trend for transient worsening of thrombocytopenia immediately (<48 h) after BRTO, however, this was not statistically significant. Platelet count was not a predictor of post-BRTO rebleeding or patient survival. However, MELD-score, albumin, international normalized ratio (INR), and etiology were predictors of rebleeding.
Conclusion: Thrombocytopenia is very common (>90% of patients) in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt) has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.
Keywords: Balloon-occluded Retrograde Transvenous Obliteration, Balloon-occlusion, Bleeding, Gastric Varices, Platelet Count

Cited in 3 Documents

  1. Yasukazu Kako, Koichiro Yamakado, Wataru Jomoto, Toshiya Nasada, Koichiro Asada, Haruyuki Takaki, Kaoru Kobayashi, Takashi Daimon and Shozo Hirota (2017) Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt. Jpn J Radiol 35(7):366. doi: 10.1007/s11604-017-0647-6
  2. Cyriac Abby Philips, Lijesh Kumar and Philip Augustine (2017) Shunt occlusion for portosystemic shunt syndrome related refractory hepatic encephalopathy—A single-center experience in 21 patients from Kerala. Indian J Gastroenterol 36(5):411. doi: 10.1007/s12664-017-0787-8
  3. Wael E. Saad (2014) Endovascular Management of Gastric Varices. Clinics in Liver Disease 18(4):829. doi: 10.1016/j.cld.2014.07.005

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