Gastroenterology Unit, A. Cardarelli Hospital, Naples, Italy.
J Clin Gastroenterol. 2010 Jul;44(6):448-51. doi: 10.1097/MCG.0b013e3181b3ab44.
Treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis is not well established.
We intended to assess the safety and efficacy of low molecular weight heparin (LMWH) to treat PVT in cirrhotic patients.
All 39 patients diagnosed with non-neoplastic PVT and cirrhosis from June 2005 to December 2006 were evaluated for anticoagulation therapy (AT). PVT was occludent in 15.4%, partial in 64.1%, and portal cavernoma presented in 20.5%. Twenty-eight patients received 200 U/kg/d of enoxaparin for at least 6 months. In 39.3% of patients PVT was an occasional finding, in 10.7% presented with acute abdominal pain, in 50% with bleeding from gastroesophageal varices. In this last group LMWH was started after endoscopic eradication of varices by band ligation.
Complete recanalization of portal vein occurred in 33.3%, partial recanalization in 50% and no response in 16.7% of patients. Further 12 patients who continued AT obtained complete recanalization at a median time of 11 months (range 7 to 17 mo). Overall, a complete response was obtained in 75% of patients. No significant side effects, particularly bleeding complications, were observed during the treatment.
LMWH demonstrated safe and effective in the treatment of PVT in patients with liver cirrhosis.
肝硬化患者门静脉血栓（PVT）的治疗尚未得到很好的确立。
我们旨在评估低分子肝素（LMWH）治疗肝硬化患者 PVT 的安全性和有效性。
2005 年 6 月至 2006 年 12 月期间，我们对所有 39 例诊断为非肿瘤性 PVT 和肝硬化的患者进行了抗凝治疗（AT）评估。PVT 完全闭塞占 15.4%，部分闭塞占 64.1%，门静脉海绵样变占 20.5%。28 例患者接受了至少 6 个月的 200 U/kg/d 的依诺肝素治疗。在 39.3%的患者中，PVT 是偶然发现的，10.7%的患者表现为急性腹痛，50%的患者表现为胃食管静脉曲张出血。在最后一组中，LMWH 在通过带结扎内镜消除静脉曲张后开始使用。
门静脉完全再通发生在 33.3%的患者中，部分再通发生在 50%的患者中，16.7%的患者无反应。进一步的 12 例继续 AT 的患者在中位数时间为 11 个月（范围为 7 至 17 个月）时获得了完全再通。总体而言，75%的患者获得了完全缓解。在治疗过程中未观察到明显的副作用，特别是出血并发症。
LMWH 在治疗肝硬化患者的 PVT 中表现出安全有效。
