Congly Stephen E, Lee Samuel S
Department of Medicine, University of Calgary Liver Unit, 3330 Hospital Drive NW, Calgary, AB, Canada, T2N 4N1.
Curr Gastroenterol Rep. 2013 Feb;15(2):306. doi: 10.1007/s11894-012-0306-0.
Portal vein thrombosis (PVT) can contribute to significant morbidity and mortality; in patients with cirrhosis, this can make transplant more technically challenging. Additionally, the clot may extend further into the mesenteric and splenic veins, and disturbance of the hepatic blood flow may lead to faster progression of the cirrhosis. Development of PVT is associated with local risk factors, and many patients have associated systemic prothrombotic factors. Anticoagulation in noncirrhotic patients should be initiated at diagnosis, using low-molecular-weight heparin overlapping with vitamin K antagonists. Cirrhotic patients with PVT should be screened for varices and then anticoagulated with low-molecular-weight heparin for at least a 6-month period. All patients should be assessed for triggering factors and tumors, as well as systemic prothrombotic factors. Newer evidence suggests that prophylactic anticoagulation in patients with cirrhosis may have a role in clinical management with decreased incidence of PVT and improved survival; further study is needed.
门静脉血栓形成（PVT）可导致严重的发病率和死亡率；在肝硬化患者中，这会使移植手术在技术上更具挑战性。此外，血栓可能会进一步延伸至肠系膜静脉和脾静脉，肝血流紊乱可能会导致肝硬化进展加快。PVT的发生与局部危险因素有关，许多患者还伴有全身性血栓形成前因素。非肝硬化患者一旦确诊应立即开始抗凝治疗，使用低分子量肝素并与维生素K拮抗剂重叠使用。患有PVT的肝硬化患者应筛查静脉曲张，然后用低分子量肝素进行至少6个月的抗凝治疗。所有患者均应评估触发因素、肿瘤以及全身性血栓形成前因素。最新证据表明，肝硬化患者的预防性抗凝治疗可能在临床管理中发挥作用，可降低PVT的发生率并提高生存率；尚需进一步研究。
