Background: Native portal vein thrombosis (PVT) in children, that is not associated with liver transplantation, is often chronic and associated with bleeding risks due to the development of portal hypertension and esophageal varices, making anticoagulation challenging. While there are case series describing surgical interventions, standard practice for and outcomes after antithrombotic therapies have not been established.

Aims: We report 20 cases of pediatric patients with native PVT, not associated with liver transplant, to describe the outcomes after antithrombotic therapy.

Methods: A retrospective chart review was conducted of 20 pediatric PVT patients referred to interventional radiology who underwent at least one attempt at percutaneous recanalization at Texas Children’s Hospital from 2014 to 2019.

Results: There were 8 cases of initially unsuccessful recanalization; 4 (50%) of these received antithrombotics. Of the 12 who had successful recanalization, 11 (92%) received antithrombotics. Of the 15 on antithrombotic therapy after recanalization attempt, 5 (30%) received antiplatelet agents alone, 1 (1%) received anticoagulation alone, 3 (20%) received anticoagulants transitioned to antiplatelet therapy, and 6 (40%) received a combination of antiplatelet and anticoagulant therapies. Of these 15 patients, 11 (73%) patients had recurrence/progression of PVT and 5 (33%) reported bleeding (2 with gastrointestinal (GI) bleeding, 2 with bruising, 1 with both GI bleeding and bruising). Of the 5 not receiving antithrombotics, 2 (40%) patients had bleeding prior to procedure, precluding antithrombotic therapy, but the other 3 (60%) had no bleeding.

Conclusions: In our case series of native PVT, there was no significant association of antithrombotic therapy preventing recurrence or progression of PVT after angioplasty/recanalization. GI bleeding and bruising occurred in one-third of patients while on antithrombotic therapy.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/utility-of-antithrombotic-therapy-in-pediatric-portal-vein-thrombosis-after-endovascular-procedure/