{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:03:55Z","timestamp":1782219835531,"version":"3.54.5"},"reference-count":26,"publisher":"Scientific Scholar","content-domain":{"domain":["clinicalimagingscience.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\"><jats:title>Objectives:<\/jats:title><jats:p>Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO) have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included), and to assess the effect of BRTO on platelet count over a 1-year period.<\/jats:p><\/jats:sec><jats:sec id=\"st2\"><jats:title>Materials and Methods:<\/jats:title><jats:p>This is a retrospective review of 35 patients who underwent BRTO (March 2008\u2013August 2011). Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma) were analyzed (multivariate analysis). A total of 91% (<jats:italic>n<\/jats:italic>= 32\/35) of patients had thrombocytopenia (&lt;150,000 platelet\/cm<jats:sup>3<\/jats:sup>) pre-BRTO. Platelet counts at within 48-h, within 2 weeks and at 30-60 days intervals (up to 6 months) after BRTO were compared with the baseline pre-BRTO values.<\/jats:p><\/jats:sec><jats:sec id=\"st3\"><jats:title>Results:<\/jats:title><jats:p>35 Patients with adequate platelet follow-up were found. A total of 92% and 17% of patients had a platelet count of &lt;150,000\/cm<jats:sup>3<\/jats:sup>and &lt;50,000\/cm<jats:sup>3<\/jats:sup>, respectively. There was a trend for transient worsening of thrombocytopenia immediately (&lt;48 h) after BRTO, however, this was not statistically significant. Platelet count was not a predictor of post-BRTO rebleeding or patient survival. However, MELD-score, albumin, international normalized ratio (INR), and etiology were predictors of rebleeding.<\/jats:p><\/jats:sec><jats:sec id=\"st4\"><jats:title>Conclusion:<\/jats:title><jats:p>Thrombocytopenia is very common (&gt;90% of patients) in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt) has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.<\/jats:p><\/jats:sec>","DOI":"10.4103\/2156-7514.131743","type":"journal-article","created":{"date-parts":[[2014,4,29]],"date-time":"2014-04-29T11:01:26Z","timestamp":1398769286000},"page":"24","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count"],"prefix":"10.25259","volume":"4","author":[{"given":"W. E.","family":"Saad","sequence":"first","affiliation":[{"name":"Department of Radiology, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Bleibel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Owensboro Health Gastroenterology and Hepatology, Kentucky, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Adenaw","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. E.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. F.","family":"Angle","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Al-Osaimi","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G.","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Surgery, Methodist Hospital, Cornell-Weiel School of Medicine, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Virginia, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2014,4,30]]},"reference":[{"key":"10.4103\/2156-7514.131743\/ref-1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.jvir.2010.01.017","article-title":"Can balloon-occluded retrograde transvenous obliteration be performed for gastric varices without gastrorenal shunts?","volume":"21","author":"Araki","year":"2010","journal-title":"J Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-2","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3748\/wjg.14.448","article-title":"Management of gastric fundal varices without gastro-renal shunt in 15 patients","volume":"14","author":"Kameda","year":"2008","journal-title":"World J Gastroenterol"},{"key":"10.4103\/2156-7514.131743\/ref-3","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1053\/j.tvir.2012.07.006","article-title":"Balloon-occluded retrograde transvenous obliteration of gastric varices from unconventional systemic veins in the absence of gastrorenal shunts","volume":"15","author":"Araki","year":"2012","journal-title":"Tech Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-4","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1055\/s-0031-1284453","article-title":"Medical and endoscopic management of gastric varices","volume":"28","author":"Al-Osaimi","year":"2011","journal-title":"Semin Intervent Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-5","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1053\/j.tvir.2012.07.003","article-title":"Pre- and post-balloon-occluded retrograde transvenous obliteration clinical evaluation, management, and imaging: Indications, management protocols and follow-up","volume":"15","author":"Saad","year":"2012","journal-title":"Tech Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1053\/j.gastro.2012.10.001","article-title":"Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis","volume":"144","author":"Berzigotti","year":"2013","journal-title":"Gastroenterology"},{"key":"10.4103\/2156-7514.131743\/ref-7","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1111\/j.1572-0241.2006.00874.x","article-title":"Platelet count\/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study","volume":"101","author":"Giannini","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"10.4103\/2156-7514.131743\/ref-8","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jamcollsurg.2011.01.004","article-title":"Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: A multi-institutional analysis","volume":"212","author":"Maithel","year":"2011","journal-title":"J Am Coll Surg"},{"key":"10.4103\/2156-7514.131743\/ref-9","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1111\/liv.12199","article-title":"Influence of clinically significant portal hypertension on survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients","volume":"33","author":"Giannini","year":"2013","journal-title":"Liver Int"},{"key":"10.4103\/2156-7514.131743\/ref-10","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1055\/s-0031-1284460","article-title":"Balloon-occluded retrograde transvenous obliteration (BRTO): Technical results and clinical outcomes","volume":"28","author":"Saad","year":"2011","journal-title":"Semin Intervent Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-11","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1440-1746.1996.tb00010.x","article-title":"Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration","volume":"11","author":"Kanagawa","year":"1996","journal-title":"J Gastroenterol Hepatol"},{"key":"10.4103\/2156-7514.131743\/ref-12","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1148\/rg.234025044","article-title":"Transcatheter obliteration of gastric varices: Part-1: Anatomic classification","volume":"23","author":"Kiyosue","year":"2003","journal-title":"Radiographics"},{"key":"10.4103\/2156-7514.131743\/ref-13","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1148\/rg.234025135","article-title":"Transcatheter Obliteration of Gastric Varices: Part-2: Strategy and techniques based on hemodynamic features","volume":"23","author":"Kiyosue","year":"2003","journal-title":"Radiographics"},{"key":"10.4103\/2156-7514.131743\/ref-14","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.2214\/ajr.178.5.1781167","article-title":"Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage","volume":"178","author":"Kitamoto","year":"2002","journal-title":"AJR Am J Roentgenol"},{"key":"10.4103\/2156-7514.131743\/ref-15","doi-asserted-by":"crossref","first-page":"369","DOI":"10.2214\/ajr.183.2.1830369","article-title":"TIPS versus transcatheter sclerotherapy for gastric varices","volume":"183","author":"Ninoi","year":"2004","journal-title":"AJR Am J Roentgenol"},{"key":"10.4103\/2156-7514.131743\/ref-16","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.2214\/ajr.184.4.01841340","article-title":"Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: Long-term follow-up in 78 patients","volume":"184","author":"Ninoi","year":"2005","journal-title":"AJR Am J Roentgenol"},{"key":"10.4103\/2156-7514.131743\/ref-17","first-page":"1379","article-title":"Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices","volume":"51","author":"Chikamori","year":"2004","journal-title":"Hepatogastroenterology"},{"key":"10.4103\/2156-7514.131743\/ref-18","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/S0039-6060(01)21563-3","article-title":"Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts","volume":"129","author":"Chikamori","year":"2001","journal-title":"Surgery"},{"key":"10.4103\/2156-7514.131743\/ref-19","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/1538574412460769","article-title":"Balloon occlusion catheter rupture during balloon-occluded retrograde transvenous obliteration of gastric varices utilizing sodium tetradecyl sulfate: Incidence and consequences","volume":"46","author":"Saad","year":"2012","journal-title":"Vasc Endovasc Surg"},{"key":"10.4103\/2156-7514.131743\/ref-20","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1053\/j.tvir.2012.07.005","article-title":"Inventory used for balloon-occluded retrograde (BRTO) and antegrade (BATO) transvenous obliteration: Sclerosant and balloon-occlusion devices","volume":"15","author":"Saad","year":"2012","journal-title":"Tech Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.cld.2008.09.010","article-title":"The platelet and platelet function testing in liver disease","volume":"13","author":"Hugenholtz","year":"2009","journal-title":"Clin Liver Dis"},{"key":"10.4103\/2156-7514.131743\/ref-22","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/MOH.0b013e32830a9746","article-title":"Thrombocytopenia in liver disease","volume":"15","author":"Giannini","year":"2008","journal-title":"Curr Opin Hematol"},{"key":"10.4103\/2156-7514.131743\/ref-23","article-title":"For the Expert Panel on Interventional Radiology for the American College of Radiology","author":"Saad","year":"2012","journal-title":"ACR Appropriateness Criteria: Radiologic Management of Gastric Varices"},{"key":"10.4103\/2156-7514.131743\/ref-24","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1053\/j.tvir.2013.02.002","article-title":"Vascular anatomy and the morphologic and hemodynamic classification of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure","volume":"16","author":"Saad","year":"2013","journal-title":"Tech Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-25","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1053\/j.tvir.2013.02.003","article-title":"The conventional balloon-occluded retrograde transvenous obliteration procedure: Indications, contraindications and technical applications","volume":"16","author":"Saad","year":"2013","journal-title":"Tech Vasc Interv Radiol"},{"key":"10.4103\/2156-7514.131743\/ref-26","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/tri.12064","article-title":"Peripheral platelet count correlates with liver atrophy and predicts long-term mortality on the liver transplant waiting list","volume":"26","author":"Bleibel","year":"2013","journal-title":"Traspl Int"}],"container-title":["Journal of Clinical Imaging Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/clinicalimagingscience.org\/thrombocytopenia-in-patients-with-gastric-varices-and-the-effect-of-balloon-occluded-retrograde-transvenous-obliteration-on-the-platelet-count\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinicalimagingscience.org\/thrombocytopenia-in-patients-with-gastric-varices-and-the-effect-of-balloon-occluded-retrograde-transvenous-obliteration-on-the-platelet-count\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T14:00:33Z","timestamp":1648908033000},"score":1,"resource":{"primary":{"URL":"https:\/\/clinicalimagingscience.org\/thrombocytopenia-in-patients-with-gastric-varices-and-the-effect-of-balloon-occluded-retrograde-transvenous-obliteration-on-the-platelet-count\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,4,30]]},"references-count":26,"alternative-id":["10.4103\/2156-7514.131743"],"URL":"https:\/\/doi.org\/10.4103\/2156-7514.131743","relation":{},"ISSN":["2156-7514"],"issn-type":[{"value":"2156-7514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,4,30]]},"article-number":"24"}}