Perioperative Strategies and Thrombophilia in Children with Extrahepatic Portal Vein Obstruction Undergoing the Meso-Rex Bypass

Rukhmi Bhat*, Timothy B Lautz, Riccardo A Superina, Robert I Liem

*Corresponding author for this work

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Background/Purpose: Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children. Objective: The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass. Methods: Records of children who underwent meso-Rex bypass for EHPVO at a single institution from 1999 to 2009 were reviewed, and preoperative thrombophilia testing, perioperative anticoagulation strategies, and postoperative bypass patency based on imaging at last follow-up were examined. Results: Sixty-five children with EHPVO underwent a first time meso-Rex bypass during the study period, and 9 of 65 (14 %) developed bypass thrombosis. The use of warfarin in the postoperative period was more common among children with thrombosed shunts than among those with open shunts [63 % vs. 20 %; OR, 6. 5 (95 % CI, 1. 3-31. 5), p = 0. 022]. The contribution of genetic or acquired thrombophilia to shunt thrombosis was inconclusive given variability in testing. Conclusions: Choice of anticoagulation following meso-Rex bypass may affect postoperative incidence of bypass thrombosis. Role of thrombophilic risk factors in the development of shunt thrombosis remains unclear.

Original languageEnglish (US)
Pages (from-to)949-955
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number5
DOIs
StatePublished - Feb 11 2013

Fingerprint

Thrombophilia
Portal Vein
Thrombosis
Portal Hypertension
Warfarin
Postoperative Period
Incidence

Keywords

  • Anticoagulation
  • Extrahepatic portal vein obstruction
  • Meso-Rex bypass
  • Thrombophilia
  • Thrombosis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{8264cd8358684d379a6e2278c9de1404,
title = "Perioperative Strategies and Thrombophilia in Children with Extrahepatic Portal Vein Obstruction Undergoing the Meso-Rex Bypass",
abstract = "Background/Purpose: Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children. Objective: The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass. Methods: Records of children who underwent meso-Rex bypass for EHPVO at a single institution from 1999 to 2009 were reviewed, and preoperative thrombophilia testing, perioperative anticoagulation strategies, and postoperative bypass patency based on imaging at last follow-up were examined. Results: Sixty-five children with EHPVO underwent a first time meso-Rex bypass during the study period, and 9 of 65 (14 {\%}) developed bypass thrombosis. The use of warfarin in the postoperative period was more common among children with thrombosed shunts than among those with open shunts [63 {\%} vs. 20 {\%}; OR, 6. 5 (95 {\%} CI, 1. 3-31. 5), p = 0. 022]. The contribution of genetic or acquired thrombophilia to shunt thrombosis was inconclusive given variability in testing. Conclusions: Choice of anticoagulation following meso-Rex bypass may affect postoperative incidence of bypass thrombosis. Role of thrombophilic risk factors in the development of shunt thrombosis remains unclear.",
keywords = "Anticoagulation, Extrahepatic portal vein obstruction, Meso-Rex bypass, Thrombophilia, Thrombosis",
author = "Rukhmi Bhat and Lautz, {Timothy B} and Superina, {Riccardo A} and Liem, {Robert I}",
year = "2013",
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day = "11",
doi = "10.1007/s11605-013-2155-z",
language = "English (US)",
volume = "17",
pages = "949--955",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
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TY - JOUR

T1 - Perioperative Strategies and Thrombophilia in Children with Extrahepatic Portal Vein Obstruction Undergoing the Meso-Rex Bypass

AU - Bhat, Rukhmi

AU - Lautz, Timothy B

AU - Superina, Riccardo A

AU - Liem, Robert I

PY - 2013/2/11

Y1 - 2013/2/11

N2 - Background/Purpose: Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children. Objective: The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass. Methods: Records of children who underwent meso-Rex bypass for EHPVO at a single institution from 1999 to 2009 were reviewed, and preoperative thrombophilia testing, perioperative anticoagulation strategies, and postoperative bypass patency based on imaging at last follow-up were examined. Results: Sixty-five children with EHPVO underwent a first time meso-Rex bypass during the study period, and 9 of 65 (14 %) developed bypass thrombosis. The use of warfarin in the postoperative period was more common among children with thrombosed shunts than among those with open shunts [63 % vs. 20 %; OR, 6. 5 (95 % CI, 1. 3-31. 5), p = 0. 022]. The contribution of genetic or acquired thrombophilia to shunt thrombosis was inconclusive given variability in testing. Conclusions: Choice of anticoagulation following meso-Rex bypass may affect postoperative incidence of bypass thrombosis. Role of thrombophilic risk factors in the development of shunt thrombosis remains unclear.

AB - Background/Purpose: Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children. Objective: The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass. Methods: Records of children who underwent meso-Rex bypass for EHPVO at a single institution from 1999 to 2009 were reviewed, and preoperative thrombophilia testing, perioperative anticoagulation strategies, and postoperative bypass patency based on imaging at last follow-up were examined. Results: Sixty-five children with EHPVO underwent a first time meso-Rex bypass during the study period, and 9 of 65 (14 %) developed bypass thrombosis. The use of warfarin in the postoperative period was more common among children with thrombosed shunts than among those with open shunts [63 % vs. 20 %; OR, 6. 5 (95 % CI, 1. 3-31. 5), p = 0. 022]. The contribution of genetic or acquired thrombophilia to shunt thrombosis was inconclusive given variability in testing. Conclusions: Choice of anticoagulation following meso-Rex bypass may affect postoperative incidence of bypass thrombosis. Role of thrombophilic risk factors in the development of shunt thrombosis remains unclear.

KW - Anticoagulation

KW - Extrahepatic portal vein obstruction

KW - Meso-Rex bypass

KW - Thrombophilia

KW - Thrombosis

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JO - Journal of Gastrointestinal Surgery

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