key: cord-0909966-97xj27k5
authors: Premkumar, Madhumita; Bhujade, Harish; Karki, Tanka; Chaluvashetty, Sreedhara B.; Kaur, Harmanpreet; Duseja, Ajay Kumar; Singh, Virendra
title: New Portal Vein Thrombosis in Cirrhosis-is the thrombophilia exacerbated due to Vaccine or COVID-19?
date: 2021-11-08
journal: J Clin Exp Hepatol
DOI: 10.1016/j.jceh.2021.10.149
sha: b811b8c705a36e749ef9e4f4ab8c800b35af4489
doc_id: 909966
cord_uid: 97xj27k5

nan

Herein we report 6 cases of new onset PVT, who were on hepatocellular carcinoma (HCC) surveillance imaging and were diagnosed with new main PVT or branch PVT following COVID 19 infection in 3 cases and following vaccination with ChAdOx1 nCoV-19

Coronavirus vaccine (recombinant)in 3 cases. The surveillance protocol at our institute is based on an Ultrasound Doppler imaging every 3 months and a semi-annual triple computed tomography (CT) or magnetic resonance imaging (MRI). All 6 patients had confirmed PVT on either CT or MRI. (Table 1) The mean time since the last screening imaging was 95± 22.5 days.

These patients were aged 49.1 ± 7.7 years, 3 (50%) were ethanol related, 66.6% were male, with 2 patients with Non-alcoholic fatty liver disease (NAFLD) having diabetes mellitus and one having hypertension as comorbidities. None of the patients had associated HCC, and all tested negative for JAK2 and Factor V Leiden mutation. One patient presented with acute variceal bleeding requiring endotherapy, while the others had mild epigastric pain. Table 1 summarizes the clinical presentations and timeline to thrombosis of each patient. Using Hill's criteria to establish causality, a probable association was found for 2 of the patients who had strong temporal association of developing PVT after vaccination. A detailed drug history did not reveal use of any medicine which could have caused thrombosis. Although cirrhosis per se is a procoagulant condition, we were unable to find any other confounders or underlying hematological conditions which could have caused the PVT. Figure 1 shows the imaging of patients 3,4, and 6 which shows the acute PVT, and early formation of collaterals. In conclusion, the key message that needs to be propagated is that COVID-19 vaccines are safe and prevent deaths due to SARS-CoV-2. All eligible patients with chronic liver disease should be offered vaccination to protect from COVID-19 related mortality. However, the thrombotic perturbations uncovered in the COVID-19 era have critical relevance for patients with cirrhosis and surveillance for venous and arterial thromboembolism needs to be incorporated in clinical practice in the post COVID era. 

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In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items, the time frame for disclosure is the past 36 months. a) The Authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript b) The Authors who have taken part in this study do not have a relationship with the manufacturers of the drugs involved either in the past or present and did not receive funding from the manufacturers to carry out their research. The Authors received support from …..

c) The Authors who have taken part in this study have declared a relationship with the manufacturers of the drugs involved.

d) The Authors have declared that they received funding from the drug companies involved in order to carry out their research in this manuscript.

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Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases

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