PARTIAL PORTAL DECOMPRESSION ALLEVIATES THROMBOCYTOPENIA OF PORTAL-HYPERTENSION

Thrombocytopenia due to splenic sequestration of platelets occurs comm only in patients with portal hypertension. Partial portal decompressio n for bleeding esophagogastric varices, via the small diameter H-graft portacaval shunt (HGPS), is intended to partially decompress the port al system below bleeding threshold but also to maintain a degree of po rtal hypertension sufficient to maintain prograde portal perfusion. Th is study was undertaken to determine whether the reduction of portal p ressures seen in patients undergoing HGPS is sufficient to relieve the thrombocytopenia seen in patients with portal hypertension. A total o f 74 patients underwent small diameter HGPS for bleeding esophagogastr ic varices not amenable to medical management. Thirty-four (46%) patie nts had thrombocytopenia (platelet count <80,000/mL) before shunting. Platelet counts were obtained preshunt, at discharge, and from 1 to 3 years after shunting. Portal pressures decreased significantly from 30 mm Hg +/- 5.6 (SD) pre shunt to 19 mm Hg +/- 5.8 (SD) after shunting ( P <0.001). Platelet counts increased from a pre-shunt value of 61,000/ mL +/- 2,700 (SEM) to a platelet count of 139,000/mL +/- 21,800 (SEM) at discharge (P <0.006) and to 102,000/mL +/- 17,500 (SEM) 1 to 3 year s after shunting (P <0.001). Patients undergoing portasystemic shuntin g for bleeding esophagogastric varices are frequently thrombocytopenic . Partial portal decompression using the 8 mm HGPS is sufficient to al leviate thrombocytopenia associated with portal hypertension immediate ly following HGPS and for years to follow. The presence of thrombocyto penia does not preclude the use of partial portal decompression in pat ients with bleeding varices requiring operative intervention.