Service d'Hépatologie, AP-HP, Institut National de la Santé et de la Recherche Médicale U773 and Université Denis Diderot-Paris 7, Hopital Beaujon, Clichy, France.
Hepatology. 2010 Jan;51(1):210-8. doi: 10.1002/hep.23259.
Current recommendations for early anticoagulation in acute portal vein thrombosis unrelated to cirrhosis or malignancy are based on limited evidence. The aim of this study was to prospectively assess the risk factors, outcome, and prognosis in patients managed according to these recommendations. We enrolled 102 patients with acute thrombosis of the portal vein, or its left or right branch. Laboratory investigations for prothrombotic factors were centralized. Thrombus extension and recanalization were assessed by expert radiologists. A local risk factor was identified in 21% of patients, and one or several general prothrombotic conditions in 52%. Anticoagulation was given to 95 patients. After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and the superior mesenteric vein in 73% (versus 42% initially). Failure to recanalize the portal vein was independently related to the presence of ascites (hazard ratio 3.8, 95% confidence interval 1.3-11.1) and an occluded splenic vein (hazard ratio 3.5, 95% confidence interval 1.4-8.9). Gastrointestinal bleeding and intestinal infarction occurred in nine and two patients, respectively. Two patients died from causes unrelated to thrombosis or anticoagulation therapy.
Recanalization occurs in one-third of patients receiving early anticoagulation for acute portal vein thrombosis, whereas thrombus extension, intestinal infarction, severe bleeding, and death are rare. Alternative therapy should be considered when ascites and splenic vein obstruction are present.
本研究旨在前瞻性评估根据这些建议进行治疗的患者的风险因素、结局和预后。
我们纳入了 102 例急性门静脉血栓形成患者（门静脉及其左或右支），或其左或右支血栓形成。集中进行了血栓形成危险因素的实验室检查。由专家放射科医生评估血栓延伸和再通情况。在 21%的患者中发现了局部危险因素，在 52%的患者中发现了一种或多种一般血栓形成情况。对 95 例患者进行了抗凝治疗。中位随访 234 天后，39%的抗凝患者（与初始时的 13%相比）门静脉及其左或右支再通，80%的患者（与初始时的 57%相比）脾静脉再通，73%的患者（与初始时的 42%相比）肠系膜上静脉再通。门静脉再通失败与腹水（危险比 3.8，95%置信区间 1.3-11.1）和闭塞的脾静脉（危险比 3.5，95%置信区间 1.4-8.9）独立相关。9 例患者发生胃肠道出血，2 例患者发生肠梗死。2 例患者因与血栓形成或抗凝治疗无关的原因死亡。
在接受急性门静脉血栓形成早期抗凝治疗的患者中，有三分之一的患者出现再通，而血栓延伸、肠梗死、严重出血和死亡较为少见。当存在腹水和脾静脉阻塞时，应考虑替代治疗。
