[Changes in hematologic and hemostatic parameters after transjugular intrahepatic portosystemic shunt (TIPS)...

The pathogenesis of thrombocyte- and leukopenia associated with liver cirrhosis is far from being understood. Hypersplenism is considered to play a major role in this hematologic complication. The effect of transjugular intrahepatic portosystemic shunt (TIPS) implantation--a more recent technique in portal decompression--on platelet count is controversial in the literature. One of the main problems related to TIPS is the frequent occurrence of shunt malfunctions. There have been no reports on consistent clinical or biochemical parameters being able to predict the occlusive and rebleeding episodes after TIPS implantation.

Platelet counts, white blood cell counts and different haemostatic data (prothrombin time, activated partial thromboplastin time and fibrinogen level) of the 24 patients undergoing TIPS placement were analyzed retrospectively prior to the procedure, after one month, after 3 months and 3 monthly thereafter for 18 months.

The portal pressure gradient decreasing below the desired 12 mmHg after TIPS placement seems to be the only factor, which can result in moderate but significant increase in platelet counts. There was no significant alteration in white blood cell counts during the follow-up period. The different haemostatic parameters scattered in a wide range, no real tendency was demonstrable. Patients in whom recurrent variceal bleeding occurred, the platelet count at the 3rd month was significantly lower compared to the basal platelet count. The decrease in the platelet count preceded shunt malfunction detected with color-Doppler or the appearance of the clinical symptoms.

Monitoring platelet count may be of prognostic interest in the assessment of the shunt function and the risk of imminent variceal rebleedings during the follow-up period.