SSC Subcommittee on Hemostatic Management of Patients With Liver Diseases

70yrs male patient with HCC Stage C 

Brachytherapy done 2 cycles 

AFP downgoing trend from 52 to 15

with underlying  IHD- single vessel disease- on plavix 

latest echo EF 65% 

DM on metformin 

HPT- on perindropril 

recently started on propranolol 

plavix withold in view of low platelet counts.

imaging shows evidence of portal vein thrombosis. 
Can anticoagulant be started ? 

Dear Doctor , 

A difficult case to manage .

First of all we  should recognize one point that  Portal Vein & Splanchnic  vein thrombosis in CLD is due to Portal  Hypertension more than due to thrombophilic causes - heredetary & acquired ones.

In CLD hemostasis balance is reset compared to non cirrhotic individual .

Imaging  will  tell us whether it is Acute PVT  or chronic .

If it is chronic with cavernomas , one may not require anticoagulation  unless  there is extension of thrombosis Or  symptoms of intestinal  ischemia .

In your case  one can  consider Apixaban 2.5  mg  BID ,after considering all merits & demerits of anticoagulation like bleeding risk , variceal status , baseline PT & APTT , platelet counts etx .

Finally depends on the Performance Status of the patient - 

Regards 

70yrs male patient with HCC Stage C 

Brachytherapy done 2 cycles 

AFP downgoing trend from 52 to 15

with underlying  IHD- single vessel disease- on plavix 

latest echo EF 65% 

DM on metformin 

HPT- on perindropril 

recently started on propranolol 

plavix withold in view of low platelet counts.

imaging shows evidence of portal vein thrombosis. 
Can anticoagulant be started ?