Letters To The Editor
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World J Gastroenterol. Aug 28, 2014; 20(32): 11463-11466
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11463
Nonselective β-blockers may induce development of portal vein thrombosis in cirrhosis
Xing-Shun Qi, Ming Bai, Dai-Ming Fan
Xing-Shun Qi, Ming Bai, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Xing-Shun Qi, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang 110840, Liaoning Province, China
Xing-Shun Qi, Department of Gastroenterology, 463 Hospital of Chinese PLA, Shenyang 110000, Liaoning Province, China
Author contributions: Qi XS proposed the hypothesis and drafted the manuscript; Bai M and Fan DM discussed and revised the manuscript for important intellectual content; all authors approved the final manuscript.
Correspondence to: Dai-Ming Fan, Professor, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi’an 710032, Shaanxi Province, China. fandaim@fmmu.edu.cn
Telephone: +86-29-84771537 Fax: +86-29-82539041
Received: January 4, 2014
Revised: February 13, 2014
Accepted: April 28, 2014
Published online: August 28, 2014
Processing time: 236 Days and 22.2 Hours
Abstract

Currently, nonselective β-blockers (NSBBs) are commonly used for the prevention of variceal bleeding in liver cirrhosis. The beneficial effects of NSBBs are primarily attributed to the reduction in cardiac output by blockade of β1 receptors and vasoconstriction of the splanchnic circulation by the blockade of β2 receptors. The prognostic value of occlusive portal vein thrombosis (PVT) in cirrhotic patients has been increasingly recognized. The most important risk factor for the development of PVT in liver cirrhosis is the decreased portal vein inflow velocity. Collectively, we propose that the use of NSBBs potentially increases the development of portal vein thrombosis by reducing portal vein inflow velocity. The hypothesis should be confirmed by prospective cohort studies, in which cirrhotic patients without prior PVT treated with and without NSBBs are enrolled, and the development of PVT during follow-up is compared between the two groups. Additionally, subgroup analyses should be performed according to the dosage of NSBBs and the reduction of portal inflow velocity after use of NSBBs.

Keywords: Non-selective β-blockers; Propranolol; Nadolol; Portal vein thrombosis; Liver cirrhosis

Core tip: Non-selective β-blockers can reduce portal flow velocity and induce development of portal vein thrombosis in liver cirrhosis.