Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2005; 11(32): 5064-5067
Published online Aug 28, 2005. doi: 10.3748/wjg.v11.i32.5064
Recurrent thrombotic occlusion of a transjugular intrahepatic portosystemic stent-shunt due to activated protein C resistance
Elmar Siewert, Jan Salzmann, Edmund Purucker, Karl Schürmann, Siegfried Matern
Elmar Siewert, Jan Salzmann, Edmund Purucker, Siegfried Matern, Department of Internal Medicine III, Aachen University, Aachen, Germany
Karl Schürmann, Department of Diagnostic Radiology, Aachen University, Aachen, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Elmar Siewert, Pauwelsstr. 30, Department of Internal Medicine III, Aachen University, Aachen D-52074, Germany. siewert@rwth-aachen.de
Telephone: +49-241-8088634 Fax: +49-241-8082455
Received: December 30, 2004
Revised: January 10, 2005
Accepted: January 13, 2005
Published online: August 28, 2005
Abstract

The transjugular intrahepatic portosystemic stent-shunt (TIPS) has successfully been used in the management of refractory variceal bleeding and ascites in patients with portal hypertension. Major drawbacks are the induction of hepatic encephalopathy and shunt dysfunction. We present a 59-year-old woman with alcoholic liver cirrhosis who received a TIPS because of recurrent bleeding from esophageal varices. Stent occlusion occurred 4 mo after placement of the TIPS. Laboratory testing revealed resistance to activated protein C (APC). Combination therapy with low-dose enoxaparin and clopidogrel could not prevent her recurrent stent occlusion. Finally, therapy with high-dose enoxaparin was sufficient to prevent further shunt complications up to now (follow-up period of 1 year). In conclusion, early occlusion of a TIPS warrants testing for thrombophilia. If risk factors are confirmed, anticoagulation should be intensified. There are currently no evidence-based recommendations regarding the best available anticoagulant therapy and surveillance protocol for patients with TIPS.

Keywords: Transjugular intrahepatic portosystemic stent-shunt; Resistance to activated protein C; Factor V-Leiden; Thrombophilia; Thrombosis