Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis.

Abstract

BACKGROUND:

Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia.

AIMS:

Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC).

METHODS:

Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS.

RESULTS:

One hundred ninety-two patients (male: 72.4%, age: 56 ± 10 years; MELD: 12.1 ± 3.6) underwent TIPS implantation. Higher-grade (≥ G2) thrombocytopenia (PLT < 100 G/L) was present in 54 (28.7%),  ≥ G2 anemia (Hb < 10 g/dL) in 57 (29.7%), and  ≥ G2 leukopenia (WBC < 2 G/L) in 3 (1.6%) patients pre-TIPS, respectively. Resolution of ≥ G2 thrombocytopenia, anemia, and leukopenia occurred in 24/55 (43.6%), 23/57 (40.4%), and 2/3 (66.7%), respectively. Similar results were also observed in the subgroup of patients without 'bleeding' TIPS-indication, with improvements of G ≥ 2 thrombocytopenia and of G ≥ 2 anemia in 19.8% and 10.2% of patients after TIPS, respectively.

CONCLUSIONS:

Thrombocytopenia, anemia, and leukopenia frequently improved after TIPS. Therefore, moderate- to higher-grade thrombocytopenia should not be regarded as a contraindication against TIPS, but rather be considered in case of severe thrombocytopenia-particularly prior to surgery or interventions.

• Authors: Theresa Bucsics, Katharina Lampichler, Constantin Vierziger, Maria Schoder, Florian Wolf, David Bauer, Benedikt Simbrunner, Lukas Hartl, Mathias Jachs, Bernhard Scheiner, Michael Trauner, Thomas Gruenberger, Franz Karnel, Mattias Mandorfer, Thomas Reiberger
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 67 Issue 12 Pg. 5693-5703 (12 2022) ISSN: 1573-2568 [Electronic] United States
• PMID: 35301618 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Hemoglobins

Topics

• Humans
• Male
• Middle Aged
• Aged
• Hypersplenism (etiology, surgery)
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects)
• Retrospective Studies
• Liver Cirrhosis (complications, surgery)
• Leukopenia (complications)
• Thrombocytopenia (etiology)
• Anemia (complications)
• Hemoglobins
• Treatment Outcome