Course of platelet counts in cirrhotic patients after implantation of a transjugular intrahepatic portosystemic shunt - a prospective, controlled study

Background/Aims: The pathogenesis of thrombocytopenia associated with advan ced liver disease is still controversial. To study the impact of portal dec ompression on this hematologic complication, we conducted a prospective, co ntrolled study to compare the course of platelet counts in patients after i mplantation of a transjugular intrahepatic portosystemic shunt (TIPS) with matched controls without shunts. Methods: Fifty-five TIPS patients and 110 controls matched for age, ses, Ch ild-Pugh class, etiology of liver disease and baseline platelet count were included, and followed for 1 year. Follow-up visits were scheduled after 1 month, after 3 months, and at 3-month intervals thereafter. Results: Nonparametric Mann-Whitney U-tests revealed significantly higher p latelet counts for TIPS patients as compared to controls from the Ist throu gh the 12th month (p<0.01). During the study period, the median platelet co unt of TIPS patients increased by 19.7%, from 104.0/nl (IR: 68.0) to 124.5/ nl (IR: 41.0). In contrast, during the same period the median platelet coun t of controls decreased by 17.1%, from 102.5/nl (IR: 66.0) to 85.0/nl (IR: 67.5). In the group of cases with baseline platelet counts less than or equ al to 100/nl, platelet counts had increased by at least 25% at month 12 in 65% of TIPS patients, but in only 5% of controls (p<0.001). However, normal ization of platelet counts, i.e. greater than or equal to 150/nl, was not a chieved in any case. Neither the portosystemic pressure gradient after TIPS implantation, nor the percentage of portosystemic pressure gradient reduct ion during the procedure was predictive of platelet response. Conclusions: TIPS implantation increases platelet counts significantly. How ever, portal hypertension is clearly not the only mechanism contributing to thrombocytopenia in advanced liver disease.