Reevaluating hypercoagulability in the portal vein and the impact of transjugular intrahepatic portosystemic shunt on platelet activation in cirrhosis
- 1Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty at Heinrich Heine University Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- 2Department of Diagnostic and Interventional Radiology, Faculty of Medicine & Dusseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
Abstract
Background: In liver cirrhosis, dysregulated hemostasis predisposes patients to both hemorrhagic and thrombotic complications. The portal vein (PV) is a frequent site of thrombosis, but the underlying mechanisms remain incompletely understood. Whether the PV constitutes a locally hypercoagulable environment remains controversial, as previous studies have reported conflicting findings regarding portal venous platelet activation, endothelial dysfunction, and coagulation factor alterations.
Methods: We enrolled 34 patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation. Platelet count, activation, and reactivity were assessed by flow cytometry before and after TIPS, as well as across multiple vascular compartments, including the PV, superior mesenteric vein, hepatic vein, and peripheral vein. In addition, we measured key coagulation factors involved in secondary hemostasis in the indicated vessels.
Results: Platelet counts declined with advancing liver disease, but no changes in platelet activation or reactivity were observed. Despite elevated platelet counts in the PV, we found no evidence of increased platelet activation or reactivity. Moreover, no compartment-specific differences were detected in the selected conventional coagulation parameters assessed, except for lower fibrinogen levels in the PV compared with the hepatic vein. TIPS implantation did not lead to a short-term increase in platelet activation.
Conclusions: In this cohort, we found no evidence of increased portal venous platelet activation or reactivity. Apart from lower fibrinogen levels in the PV compared with the hepatic vein, the selected conventional coagulation parameters assessed did not show consistent compartment-specific differences. These findings do not support the concept of a PV-specific hypercoagulable state as assessed by the present platelet activation and reactivity measures and selected coagulation assays. Rather, they suggest that relief of portal hypertension and reduction of venous stasis may be more relevant for thrombosis risk than changes in platelet activation alone.
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BibTeX
@article{moller2026reevaluating,
title = {{Reevaluating hypercoagulability in the portal vein and the impact of transjugular intrahepatic portosystemic shunt on platelet activation in cirrhosis}},
author = {Viktoria Möller and Anselm Kunstein and Christian Weigel and Stephanie D. Wolf and Alexander Killer and Matthias Dille and Mihael Vucur and Kai Jannusch and Eric Tietz and Tom Luedde and Peter Minko and Johannes G. Bode and Carolin Angendohr},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = sep,
doi = {10.1016/j.rpth.2026.106977},
url = {https://doi.org/10.1016/j.rpth.2026.106977},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Reevaluating hypercoagulability in the portal vein and the impact of transjugular intrahepatic portosystemic shunt on platelet activation in cirrhosis
AU - Viktoria Möller
AU - Anselm Kunstein
AU - Christian Weigel
AU - Stephanie D. Wolf
AU - Alexander Killer
AU - Matthias Dille
AU - Mihael Vucur
AU - Kai Jannusch
AU - Eric Tietz
AU - Tom Luedde
AU - Peter Minko
AU - Johannes G. Bode
AU - Carolin Angendohr
PY - 2026
DA - 2026/09/29
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.106977
UR - https://doi.org/10.1016/j.rpth.2026.106977
AB - Background: In liver cirrhosis, dysregulated hemostasis predisposes patients to both hemorrhagic and thrombotic complications. The portal vein (PV) is a frequent site of thrombosis, but the underlying mechanisms remain incompletely understood. Whether the PV constitutes a locally hypercoagulable environment remains controversial, as previous studies have reported conflicting findings regarding portal venous platelet activation, endothelial dysfunction, and coagulation factor alterations. Methods: We enrolled 34 patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation. Platelet count, activation, and reactivity were assessed by flow cytometry before and after TIPS, as well as across multiple vascular compartments, including the PV, superior mesenteric vein, hepatic vein, and peripheral vein. In addition, we measured key coagulation factors involved in secondary hemostasis in the indicated vessels. Results: Platelet counts declined with advancing liver disease, but no changes in platelet activation or reactivity were observed. Despite elevated platelet counts in the PV, we found no evidence of increased platelet activation or reactivity. Moreover, no compartment-specific differences were detected in the selected conventional coagulation parameters assessed, except for lower fibrinogen levels in the PV compared with the hepatic vein. TIPS implantation did not lead to a short-term increase in platelet activation. Conclusions: In this cohort, we found no evidence of increased portal venous platelet activation or reactivity. Apart from lower fibrinogen levels in the PV compared with the hepatic vein, the selected conventional coagulation parameters assessed did not show consistent compartment-specific differences. These findings do not support the concept of a PV-specific hypercoagulable state as assessed by the present platelet activation and reactivity measures and selected coagulation assays. Rather, they suggest that relief of portal hypertension and reduction of venous stasis may be more relevant for thrombosis risk than changes in platelet activation alone.
SN - 2475-0379
ER -