早期抗凝干预用于经颈静脉肝内门体静脉支架分流术联合PSE治疗肝硬化患者价值探讨*

doi:10.3969/j.issn.1672-5069.2020.01.023

Abstract

Abstract: Objective The aim of this study was to investigate the value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt (TIPS) combined withpartial splenic embolism (PSE). Methods 86 patients with cirrhosis and portal hypertension were recruited in our hospital between September 2016 and September 2018, and were randomly divided into two groups. All patients underwent TIPS and PSE, and after operation, the patients were divided into two groups. The patients in control received heparin and aspirin, and those in the observation received low molecular weight heparin combined with warfarin for anticoagulant intervention. All patients were followed-up for three months. Results The platelet count in the observation group was (274.3±30.2)×10⁹/L on the 7th day after operation, which was significantly higher than before operation, and PLT count in the control group was (257.6±29.7)×10⁹/L, which was also significantly higher than before operation; there were no significant differences as respect to PLT counts, prothrombin time (PT)and activated partial thrombin activity time(APTT ) between the two groups (P>0.05); On the 7th day after surgery, there were no significant differences as respect to the diameter of portal vein, the average blood velocity of portal vein and the portal vein flow between the two groups (P<0.05); there was no significant difference in the incidence of ascites, hemorrhage, hepatic encephalopathy, skin ecchymosis and fever between the two groups (P>0.05), while the incidence of portal thrombosis in the observation group was 2.5%, significantly lower than 16.7% in the control (P<0.05). Conclusion Early intervention with low molecular weight heparin combined with warfarin might effectively prevent portal vein thrombosis after TIPS combined with PSE in patients with cirrhosis, which warrants further investigation.

Key words: Liver cirrhosis, Transjugular intrahepatic portosystemic stent shunt, Partial splenic embolism, Heparin

Zhao Ping, Li Tao, Xie Jiliang, et al. Value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt combined with PSE[J]. Journal of Practical Hepatology, 2020, 23(1): 82-85.

References

[1] Bissonnette J, Carlos Garcia-Pagán J, Albillos A, et al. Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension. Hepatology, 2016, 64(1):224-231.
[2] Qi X, He C, Guo W, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis: outcomes and predictors in a prospective cohort study. Liver Int, 2016, 36(5):667-676.
[3] Wang Z, Jiang MS, Zhang HL, etal. Is post-TIPS anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? a randomized controlled trial. Radiology, 2016, 279(3):943-951.
[4] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.酒精性肝病防治指南(2018年更新版).实用肝脏病杂志,2018,21(2): 170-176.
[5] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[6] 中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[7] 游玉峰, 谭必勇, 何小俊, 等. PTIPS治疗脾切除术后并发门静脉血栓形成的门静脉高压症患者安全性和效果分析. 实用肝脏病杂志, 2018, 21(3):372-375.
[8] Lahat E, Lim C, Bhangui P, et al. Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review. Hpb, 2018,20(2):101-109.
[9] Valentin N, Korrapati P, Constantino J, et al. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis. Eur J Gastroen Hepat, 2018, 30(10):1187-1193.
[10] Busk TM,Bendtsen F, Henriksen JH, et al. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis. J Hepatol, 2016, 64(2):S453-S453.
[11] Kato A,Shimizu H, Ohtsuka M, et al. Portal vein stent placement for the treatment of postoperative portal vein stenosis: long-term success and factor associated with stent failure. Bmc Surg, 2017, 17(1):11-16.
[12] Qi X, De Stefano V, Guo X . Quality of anticoagulation and outcome of bleeding in cirrhosis. Hepatology, 2016, 64(1):320-321.
[13] Gottardi AD, Trebicka J, Klinger C, et al. Antithrombotic treatment with direct-acting oral anticoagulants (DOACs) in patients with splanchnic vein thrombosis and cirrhosis. Liver Int, 2016, 37(5):694-699.
[14] Cui SB, Shu RH, Yan SP, et al.Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B. Eur J Gastroenterol Hepat, 2015, 27(8):914-919.
[15] Loffredo L, Pastori D, Farcomeni A, et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis:a systematic review and meta-analysis. Gastroenterology, 2017, 153(2):480-487.
[16] Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int, 2015, 31(1):75-82.
[17] Helgason CM, Grossi E, Pandey D, et al. Platelet aggregation and recruitment with aspirin-clopidogrel therapy. Cerebrovasc Dis, 2015, 25(5):392-400.
[18] Ohnuki Y, Ohnuki Y, Kohara S, et al. Dual therapy with aspirin and cilostazol may improve platelet aggregation in noncardioembolic stroke patients: a pilot study. Internal Med, 2017, 56(11):1307-1313.
[19] Wu C, Alotaibi GS, Alsaleh K, et al. Case-fatality of recurrent venous thromboembolism and major bleeding associated with aspirin, warfarin, and direct oral anticoagulants for secondary prevention. Thromb Res, 2015, 135(2):243-248.
[20] Afshari D, Moradian N, Nasiri F, et al. The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis. Neurosciences, 2015, 20(4):357-361.

Value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt combined with PSE

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