Xiaowen Fan, MD1, Xiaoquan Huang, MD, PhD2, Shiyao Chen, MD, PhD2; 1Columbia University Medical Center, New York, NY; 2Zhongshan Hospital, Fudan University, Shanghai, Shanghai, China
Introduction: Factor VIII has been shown to play an important role in cirrhotic patients with hypercoagulable phenotype. However, the role of factor VIII in portal vein thrombosis (PVT) among cirrhosis has not been well studied. We aimed to evaluate the association between increased level of factor VIII and PVT occurrence, as well as the extent of thrombosis in cirrhotic patients with clinical portal hypertension. Methods: All cirrhotic patients aged 18-75 with confirmed gastroesophageal varices (GEV) seen at a regional referral center between Jan 1st, 2018 and Dec 31st 2019 were enrolled. Patients with a history of liver transplantation, TIPS, malignant tumor, or cavernous transformation of the portal vein were excluded. A total of 424 patients were included and divided into PVT group (n=96) vs non-PVT group (n=328) based on the presence of PVT on computed tomography angiography report. Results: The mean age of all included patients with cirrhosis and GEV was 57.0 ± 10.8 years, 61.1% (259) were male, 22.6% (96) with PVT, 20.5% (87) with a history of splenectomy. Factor VIII level was significantly higher in the PVT group compared with the non-PVT group (181.5 ± 65.9 % vs 160.5 ± 53.4 %, p=0.005). PVT group was also noted to have significantly higher Child-Pugh grade, MELD score, splenectomy rate, prothrombin time, and significantly lower hemoglobin and albumin level compared with non-PVT group. (Table) There were 71 cases with thrombosis in the main trunk, 26 in the left branch, 49 in the right branch, 28 in the superior mesenteric vein, and 24 in the splenic vein. Elevated factor VIII level was found to associate with increased occurrence of thrombosis in the main trunk (HR 1.007, 95% CI 1.003-1.011, p=0.001), left branch (HR 1.011, 1.001-1.017, p=0.001), right branch (HR 1.009, 1.004-1.014, p< 0.001), and superior mesenteric vein (HR 1.009, 1.003-1.015, p=0.003); however, it had no effect on the occurrence of splenic vein thrombosis (HR 0.999, 0.992-1.007, p=0.887). The level of factor VIII was positively correlated with the number of sites (0-4; main trunk, left branch, right branch, superior mesenteric vein) involved with thrombosis. (Figure) Discussion: Elevated level of factor VIII was associated with occurrence of PVT and positively correlated with the number of sites involved with thrombosis in the portal system. Further studies are required to investigate the underlying mechanism of such correlations.
Figure: The level of Factor VIII (FVIII%, Median, interquartile) and the number of sites with thrombosis in portal system
Disclosures: Xiaowen Fan indicated no relevant financial relationships. Xiaoquan Huang indicated no relevant financial relationships. Shiyao Chen indicated no relevant financial relationships.