Partial portal decompression alleviates thrombocytopenia of portal hypertension

Thrombocytopenia due to splenic sequestration of platelets occurs commonly in patients with portal hypertension. Partial portal decompression for bleeding esophagogastric varices, via the small diameter H-graft portacaval shunt (HGPS), is intended to partially decompress the portal system below bleeding threshold but also to maintain a degree of portal hypertension sufficient to maintain prograde portal perfusion. This study was undertaken to determine whether the reduction of portal pressures seen in patients undergoing HGPS is sufficient to relieve the thrombocytopenia seen in patients with portal hypertension. A total of 74 patients underwent small diameter HGPS for bleeding esophagogastric varices not amenable to medical management. Thirty-four (46%) patients 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 30mm Hg +/- 5.6 (SD) pre shunt to 19mm 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 years after shunting (P < 0.001). Patients undergoing portasystemic shunting for bleeding esophagogastric varices are frequently thrombocytopenic. Partial portal decompression using the 8 mm HGPS is sufficient to alleviate thrombocytopenia associated with portal hypertension immediately following HGPS and for years to follow. The presence of thrombocytopenia does not preclude the use of partial portal decompression in patients with bleeding varices requiring operative intervention.