Nagaoki Yuko, Aikata Hiroshi, Daijyo Kana, Teraoka Yuji, Shinohara Fumi, Nakamura Yuki, Hatooka Masahiro, Morio Kei, Nakahara Takashi, Kawaoka Tomokazu, Tsuge Masataka, Hiramatsu Akira, Imamura Michio, Kawakami Yoshiiku, Ochi Hidenori, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Liver Research Project Center, Hiroshima University, Hiroshima, Japan.
Hepatol Res. 2018 Jan;48(1):51-58. doi: 10.1111/hepr.12895. Epub 2017 Apr 27.
To compare the efficacy and safety of edoxaban and warfarin for treatment of portal vein thrombosis (PVT) following danaparoid sodium in patients with liver cirrhosis.
Fifty cirrhotic patients with PVT treated initially for 2 weeks with danaparoid sodium were enrolled in this retrospective cohort study. Treatment was later switched to either edoxaban (n = 20) or warfarin (n = 30). We compared the efficacy and safety of edoxaban and warfarin for up to 6 months. The PVT volume was measured by dynamic computed tomography before treatment, at 2 weeks, and at 1, 3, and 6 months.
There were no significant differences in the clinical characteristics of patients in the two groups. Treatment with edoxaban reduced the volume of PVT from 1.42 cm at 2 weeks to 0.42 cm at 6 months, and prevented exacerbation of PVT at 6 months after treatment with danaparoid sodium (P = 0.016). In contrast, treatment with warfarin resulted in increased PVT volume from 1.73 cm at 2 weeks to 2.85 cm at 6 months, despite the control of the international normalized ratio in 57% of the patients (P = 0.005). Multivariate regression analysis identified edoxaban therapy as the single significant and independent determinant of PVT reduction at 6 months (P = 0.0014, hazard ratio 6.400). Clinically significant gastrointestinal bleeding was encountered in 3 of 20 (15%) patients of the edoxaban group and 2 of 30 (7%) of the warfarin group (P = 0.335).
Edoxaban following danaparoid sodium is an effective anticoagulant and could be potentially considered as one of the treatment options for PVT in cirrhotic patients.
比较依度沙班和华法林在肝硬化患者中治疗达那肝素钠治疗后门静脉血栓形成（PVT）的疗效和安全性。
本回顾性队列研究纳入了50例最初接受达那肝素钠治疗2周的肝硬化合并PVT患者。随后治疗改为依度沙班（n = 20）或华法林（n = 30）。我们比较了依度沙班和华法林长达6个月的疗效和安全性。在治疗前、2周时以及1、3和6个月时通过动态计算机断层扫描测量PVT体积。
两组患者的临床特征无显著差异。依度沙班治疗使PVT体积从2周时的1.42 cm降至6个月时的0.42 cm，并在达那肝素钠治疗6个月后预防了PVT的加重（P = 0.016）。相比之下，尽管57%的患者国际标准化比值得到控制，但华法林治疗导致PVT体积从2周时的1.73 cm增加至6个月时的2.85 cm（P = 0.005）。多因素回归分析确定依度沙班治疗是6个月时PVT缩小的唯一显著且独立的决定因素（P = 0.0014，风险比6.400）。依度沙班组20例患者中有3例（15%）发生了具有临床意义的胃肠道出血，华法林组30例患者中有2例（7%）发生了胃肠道出血（P = 0.335）。
达那肝素钠后使用依度沙班是一种有效的抗凝剂，可被视为肝硬化患者PVT的治疗选择之一。
