Non-malignant Portal Vein Thrombi in Patients with Cirrhosis Consist of Intimal Fibrosis with or without a Fibrin-rich Thrombus

E.G. Driever¹, F.A. von Meijenfeldt¹, J. Adelmeijer¹, R.J. de Haas², M.C. van den Heuvel³, C. Nagasami⁴, J.W. Weisel⁴, R.J. Porte⁵, A. Blasi⁶, N. Heaton⁷, S. Gregory⁸, P. Kane⁸, W. Bernal⁷, Y. Zen⁷, T. Lisman^1,5.

¹University Medical Center Groningen, Department of Surgery, Surgical Research Laboratory, Groningen, Netherlands, ²University Medical Center Groningen, Department of Radiology, Groningen, Netherlands, ³University Medical Center Groningen, Department of Pathology and Medical Biology, Division of Pathology, Groningen, Netherlands, ⁴University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States, ⁵University Medical Center Groningen, Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, Groningen, Netherlands, ⁶Hospital Clinic-IDIBAPS, Department of Anesthesiology, Barcelona, Spain, ⁷King's College Hospital NHS FT, Institute of Liver Studies, London, United Kingdom, ⁸King's College Hospital NHS FT, London, United Kingdom

Abstract Number: PB1172

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » Visceral Vein Thrombosis

Background: Portal vein thrombosis (PVT) is a common complication of cirrhosis. The exact pathophysiology remains largely unknown and treatment with anticoagulants only lead to recanalization of the portal vein in a proportion of patients. A better insight in the structure and composition of portal vein thrombi may assist in developing a more rational treatment approach.

Aims: The aim of this study was to define the structure and composition of portal vein thrombi in patients with cirrhosis at the time of liver transplantation.

Methods: Eight prospectively and 63 retrospectively collected non-malignant portal vein thrombi from cirrhotic patients who underwent liver transplantation were included. Histology, immunohistochemistry and scanning electron microscopy were used to assess structure and composition of the thrombi. Most recent CT scans were reanalysed for thrombus characteristics. Clinical characteristics were related to histological and radiological findings.

Results: All prospective and retrospective samples showed a thickened, fibrotic tunica intima. Fibrin-rich thrombi were present on top of the fibrotic intima in 4/8 prospective cases and in 21/63 retrospective cases. A minority of the fibrotic areas stained focally positive for fibrin(ogen) (fg, 16% of the cases), Von Willebrand Factor (VWF, 10%) and CD61 (platelets, 21%), while most of the fibrin-rich areas stained positive for those markers (fg, 100%; VWF, 77%; CD61, 100%). No associations were found between clinical characteristics including estimated thrombus age and presence of fibrin thrombi.

Conclusions: Here we demonstrated that PVT in cirrhotic patients consists of intimal fibrosis with an additional fibrin-rich thrombus in only a third of the cases. These results suggest that the majority of portal vein thrombi in cirrhotic patients are unlikely to recanalise by anticoagulant therapy.

To cite this abstract in AMA style:

Driever EG, von Meijenfeldt FA, Adelmeijer J, de Haas RJ, van den Heuvel MC, Nagasami C, Weisel JW, Porte RJ, Blasi A, Heaton N, Gregory S, Kane P, Bernal W, Zen Y, TL. Non-malignant Portal Vein Thrombi in Patients with Cirrhosis Consist of Intimal Fibrosis with or without a Fibrin-rich Thrombus [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/non-malignant-portal-vein-thrombi-in-patients-with-cirrhosis-consist-of-intimal-fibrosis-with-or-without-a-fibrin-rich-thrombus/. Accessed November 29, 2023.

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