Abstract
Background/Aims: The pathogenesis of thrombocytopenia associated with advanced liver disease is still
controversial. To study the impact of portal decompression on this hematologic complication,
we conducted a prospective, controlled study to compare the course of platelet counts
in patients after implantation of a transjugular intrahepatic portosystemic shunt
(TIPS) with matched controls without shunts.
Methods: Fifty-five TIPS patients and 110 controls matched for age, sex, Child-Pugh class,
etiology of liver disease and baseline platelet count were included, and followed
for 1 year. Follow-up visits were scheduled after 1 month, after 3 months, and at
3-month intervals thereafter.
Results: Nonparametric Mann-Whitney U-tests revealed significantly higher platelet counts
for TIPS patients as compared to controls from the 1st through the 12th month (p<0.01). During the study period, the median platelet count of TIPS patients increased
by 19.7%, from 104.0/nl (IR: 68.0) to 124.5/nl (IR: 41.0). In contrast, during the
same period the median platelet count of controls decreased by 17.1%, from 102.5/nl
(IR: 66.0) to 85.0/nl (IR: 67.5). In the group of cases with baseline platelet counts
≤100/nl, platelet counts had increased by at least 25% at month 12 in 65% of TIPS
patients, but in only 5% of controls (p<0.001). However, normalization of platelet counts, i.e. ≥150/nl, was not achieved
in any case. Neither the portosystemic pressure gradient after TIPS implantation,
nor the percentage of portosystemic pressure gradient reduction during the procedure
was predictive of platelet response.
Conclusions: TIPS implantation increases platelet counts significantly. However, portal hypertension
is clearly not the only mechanism contributing to thrombocytopenia in advanced liver
disease.
Keywords
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Article info
Publication history
Accepted:
September 7,
1998
Received in revised form:
August 31,
1998
Received:
February 19,
1998
Identification
Copyright
© 1999 Published by Elsevier Inc.
