Authors
Khoronko Yu.V., Sidorov R.V., Kosovtsev E.V., Khoronko E.Yu., Sarkisov A.E., Krivorotov N.A., Tadieva E.V., Karapetyan V.A.
Rostov State Medical University, Rostov-on-Don, Russia
Abstract
Antithrombotic therapy in patients with unstable angina is considered mandatory. However, in patients with concomitant cirrhotic portal hypertension, complicated by previously occurring variceal esophagogastric bleeding, the prescription of anticoagulants and antiplatelet agents negatively affects the effectiveness of hemostatic measures in case of recurrent hemorrhage and can lead to poor outcome.
Case report demonstrates result of TIPS procedure, supplemented by embolization of inflow tracts to the esophagogastric varices in a patient with an endoscopically established high risk of variceal re-bleeding against the background of coronary heart disease with unstable angina. Achieving effective portal decompression made it possible to prescribe the patient antithrombotic therapy, subsequently perform coronary stenting and continue the necessary therapy with a good long-term outcome in the course of both diseases.
Of total number of 307 patients with complicated portal hypertension who underwent TIPS procedure in Surgical clinic of Rostov State Medical University in 2007-23, in 27 patients portosystemic shunt intervention was performed against the background of the need for antithrombotic therapy due to comorbid pathology.
Keywords: portosystemic shunting, TIPS procedure, comorbid pathology, coronary heart disease, portal hypertension.
References
1. Tarlovskaya EI. Comorbidity and polymorbidity — a modern interpretation and urgent tasks facing the therapeutic community. Kardiologiia. 2018; 58(S9): 29-38. (In Russ.) doi: 10.18087/cardio.2562.
2. Drapkina OM, Shutov AM, Efremova EV. Comorbidity, multimorbidity, dual diagnosis — synonyms or different terms? Cardiovascular Therapy and Prevention. 2019; 18(2): 65-69. (In Russ.) doi: 10.15829/1728-8800-2019-2-65-69.
3. Skou ST, Mair FS, Fortin M, et al. Multimorbidity. Nat Rev Dis Primers. 2022; 8(1): 48. doi: 10.1038/s41572-022-00376-4.
4. Zykov MV, Dyachenko NV, Velieva RM, et al. Combined use of the GRACE ACS risk score and comorbidity indices to increase the effectiveness of hospital mortality risk assessment in patients with acute coronary syndrome. Terapevticheskii Arkhiv. 2022; 94(7): 816-821. (In Russ.) doi: 10.26442/00403660.2022.07.201742.
5. Balun A, Akgümüs A. Charlson comorbidity index and 1-year poor outcomes in elderly patients undergoing successful percutaneous coronary intervention: A retrospective study. Medicine (Baltimore). 2023; 102(19): e33792. doi: 10.1097/MD.0000000000033792.
6. Wu VCC, Chen SW, Chou AH, et al. Nationwide cohort study of acute myocardial infarction in patients with liver cirrhosis. Medicine (Baltimore). 2020; 99(12): e19575. doi: 10.1097/MD.0000000000019575.
7. Zghebi SS, Rutter MK, Sun LY, et al. Comorbidity clusters and in-hospital outcomes in patients admitted with acute myocardial infarction in the USA: A national population-based study. PLos One. 2023: 18(10): e293314. doi: 10.1371/journal.pone.0293314.
8. Lin SY, Lin CL, Lin CC, et al. Risk of acute coronary syndrome and peripheral arterial disease in chronic liver disease and cirrhosis: a nationwide population-based study. Atherosclerosis. 2018; 270: 154-159. doi: 10.1016/j.atherosclerosis.2018.01.047.
9. Shafqat S, Lohana AK, Bansari RK, Parkash O. Survival outcomes of patients with concomitant acute variceal bleeding and acute coronary syndrome, and the role of antiplatelet agents: an institutional experience from a lower middle-income Country. BMC Gastroenterology. 2022; 22: 543. doi: 10.1186/s12876-022-02611-4.
10. Liu B, Li Q, Wang H, et al. Myocardial injury is a risk factor for 6-week mortality in liver cirrhosis associated esophagogastric variceal bleeding. Sci Rep. 2023; 13: 6237. doi: 10.1038/s41598-023-33325-6.
11. Thöm R, Christensen E, Wixner J, et al. Survival after first diagnosis of oesophageal or gastric varices in a single centre in northern Sweden: a retrospective study. Clin Exp Hepatol. 2022; 8(2): 103-110. doi: 10.5114/ceh.2022.114897.
12. Pallio S, Melita G, Shahini E, et al. Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023; 13(6): 1031. doi: 10.3390/diagnostics13061031.
13. Korobka VL, Pasechnikov VD, Pak ES, et al. Liver transplant candidates delisting due to recompensation of chronic liver diseases — candidates characteristics with delisting predictors: a prospective study. Vestnik transplantologii i iskusstvennykh organov. 2019; 21(4): 26-35. (In Russ.) doi: 10.15825/1995-1191-2019-4-26-35.
14. Khoronko YuV, Kozyrevskiy MA, Dmitriev AV, et al. Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021; 31(1): 39-46. (In Russ.) doi: 10.22416/1382-4376-2021-31-1-39-46.
15. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII — Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4): 959-974. doi: 10.1016/j.jhep.2021.12.022.
16. Sun L, Long L, Wang Q, Xiang H., Members of the Expert Consensus Steering Commettee. Expert consensus on emergency procedures for portal hypertension bleeding (2022). J Interv Med. 2023; 6(1): 1-9. doi: 10.1018/j.jimed.2022.10.006.
17. Jaber F, Beran A, Alsakameh S, et al. Transjugular Intrahepatic Portosystemic Shunt With or Without Gastroesophageal Variceal Embolization for the Prevention of Variceal Rebleeding: A Systematic Review and Meta-Analysis. Gastroenterol Res. 2023; 16(2): 68-78. doi: 10.14740/gr1618.
18. Mikhiya G, Han X, Jiao D, et al. Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension. Clin Med Res. 2023; 21(3): 144-154. doi: 10.3121/cmr.2023.1796.
19. Lisman T. Bleeding and Thrombosis in Patients With Cirrhosis: What’s New? Hemasphere. 2023; 7(6): e886. doi: 10.1097/HS9.0000000000000886.
20. Lv Y, Liu N, Li Y, et al. Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients. Dis Markers. 2023; 2023: 5560560. doi: 10.1155/2023/5560560.
21. Luo SH, Zhou MM, Cai MJ, et al. Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications. World J Gastroenterol. 2023; 29(15): 2336-2348. doi: 10.3748/wjg.v29.i15.2336.
