Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis

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• 作者：Marí ; a Gabriela Delgado^鈦?/sup> ; Susana Seijo^鈦?/sup> ; Ismael Yepes^&Dagger ; ; ^§ ; ; Linette Aché ; car^鈭?/sup> ; Maria Vega Catalina^&Dagger ; ; ^§ ; ; Á ; ngeles Garcí ; a– ; Criado^¶ ; ; Juan G. Abraldes^鈦?/sup> ; ^§ ; ; Joaquí ; n de la Peñ ; a^# ; Rafael Bañ ; ares^&Dagger ; ; ^§ ; ; Agustí ; n Albillos^鈭?/sup> ; ^§ ; ; Jaume Bosch^鈦?/sup> ; ^§ ; ; Juan Carlos Garcí ; a– ; Pagá ; n^鈦?/sup> ; ^§ ; ; ^{jcgarcia@clinic.ub.es}
• 关键词：Low Molecular Weight Heparin ; Oral Anticoagulants ; Venous Thrombosis ; Portal Hypertension
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2012
• 期刊代码：pca92_15423565
• 类别：med
• 出版时间：July, 2012
• 卷：10
• 期：7
• 页码：776-783
• 文件大小：1004 K

摘要

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Background & Aims

Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there are limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT.

Methods

We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n = 31) or progression of previously known PVT (n = 24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed, and recanalization was evaluated by using Doppler ultrasound, angio-computed tomography, and/or angio-magnetic resonance imaging analyses.

Results

Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5%of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed less frequent liver-related events (portal hypertension-related bleeding, ascites, or hepatic encephalopathy) during the follow-up period, but this difference was not statistically significant (P = .1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50 脳 109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy.

Conclusions

Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60%of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis.