The effects of Transjugular Intrahepatic Portosystemic Shunt placement on von Willebrand factor levels in plasma of patients with cirrhosis and portal hypertension.

Patient with severe liver cirrhosis often suffer from portal hypertension
resulting in ascites formation, gastroesophageal varices and variceal bleeding.
Besides these hemodynamic changes, patient with cirrhosis also experience
changes in the hemostatic system due to decreased synthesis and clearance of
pro- and antihemostatic proteins by the liver. Von Willebrand factor (vWf) is
an important prohemostatic protein involved in activation and aggregation of
platelets and is synthesized by the endothelial cells and cleared by the liver.
Patients with cirrhosis often have increased levels of vWF, possibly caused by
decreased clearance by the cirrhotic liver. In recent years however,
endothelial activation as a result of portal hypertension has been indicated as
a cause of the increased vWF levels in patients with cirrhosis. Indeed, levels
of vWF were shown to be an important predictor for severity of portal
hypertension, severity of liver disease, and mortality. Formal proof that
elevated vWF levels are a direct consequence of portal hypertension is still
lacking.

To investigate whether a decrease in portal pressure after placement of a
transjugular intrahepatic portosystemic shunt results in a decline in von
Willebrand factor plasma levels.

A prospective observational study.

Participating patients will donate one blood sample of 9 ml on each of the five
time points. The blood sample will be collected during routine venapunction for
clinical laboratory measurements.
Vena punction is associated with minor discomfort and possibly minor bruising.