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Dear All
I am following a 31 yo patient (man) from Portugal with chronic occlusion of the median and left liver vein, possibly as a consequence of a traffic accident with lumbal traumatism at the age of 6. The diagnosis has been done in 2010 due to ascites, edema, abdominal discomfort and he has been anticoagulated with warfarin since. A very complete investigation for thrombophilia resulted negative. He is currently asymptomatic. One hematologist told him to stop anticoagulation in last April and he did so. I am not sure that this is a good idea. Would you continue anticoagulation? Full dose? DOACs?
Many thanks for sharing your thoughts and warm regards
Andrea De Gottardi -
Dear Andrea, If you really think that the traumatism may be the cause of the obstruction and this happens at 6 years of age and the complete thrombophilic study is negative stopping anticoagulation can be a good alternative. However, it looks like the patient had portal hyeprtension with ascites. has the patient varices?. Can you consider that the patients is not responding to medical treatment? is the patient a candidate to go a step further in the treatment?.
Best
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Dear Juan Carlos
The patient had varices that regressed over time and is responding very well to diuretic therapy for ascites. Although I feel somehow unconfortable, I think that anticoagulation could be stopped, because there is no evidence to maintain it. Whether anticoagulation in prophylactic dose makes any sense remains to be established.
Thanks a lot!
Andrea
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