Seoul National University, College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea; Chungbuk National University Hospital, Department of Internal Medicine, Cheongju, Republic of Korea.
Seoul National University, College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea; Seoul National University, College of Medicine, Cancer Research Institute, Seoul, Republic of Korea.
Thromb Res. 2018 Mar;163:71-76. doi: 10.1016/j.thromres.2018.01.032. Epub 2018 Feb 2.
Portal vein thrombosis (PVT) is a well-known complication in patients with liver cirrhosis (LC). The aim of this study is to investigate the outcomes of cirrhotic patients with PVT treated with low-molecular-weight heparin (LMWH).
Ninety-one LC patients with PVT were treated with dalteparin or enoxaparin for six months. Patients with major bleeding during the last three months, severe thrombocytopenia, or impaired renal function were excluded.
The median age was 62.9 years, and 59 patients had hepatocellular carcinoma. The overall recanalization rate was 61.5%. Patients with a favorable Child-Pugh class and those recently diagnosed as having a thrombus showed significantly better responses. In those who responded to the anticoagulation therapy, the post-treatment bilirubin and platelet levels were improved compared to those in the pre-treatment state. The relapse rate for PVT was 56.6%, and the median time to relapse was 4.0 months. Bleeding was reported in 13 patients (14.4%), and two patients died due to fatal bleeding. A history of variceal bleeding and low serum albumin were risk factors for bleeding.
LMWH therapy for PVT in LC is effective. Advanced LC and a delayed start of anticoagulation treatment decrease the effect of LMWH. Despite its effectiveness, there is a risk of hemorrhage, hence anticoagulation should be carefully considered, especially in patients with advanced LC and a history of variceal bleeding.
门静脉血栓形成（PVT）是肝硬化（LC）患者的一种常见并发症。本研究旨在探讨低分子肝素（LMWH）治疗 PVT 的肝硬化患者的结局。
91 例 LC 合并 PVT 患者接受达肝素或依诺肝素治疗 6 个月。排除近 3 个月内有大出血、严重血小板减少或肾功能受损的患者。
中位年龄为 62.9 岁，59 例患者患有肝细胞癌。总的再通率为 61.5%。Child-Pugh 分级良好和近期诊断为血栓形成的患者反应明显更好。在抗凝治疗有反应的患者中，治疗后胆红素和血小板水平较治疗前改善。PVT 的复发率为 56.6%，复发的中位时间为 4.0 个月。13 例（14.4%）患者出现出血，2 例患者因致命性出血死亡。有静脉曲张出血史和低血清白蛋白是出血的危险因素。
LMWH 治疗 LC 合并 PVT 有效。晚期 LC 和抗凝治疗开始延迟会降低 LMWH 的效果。尽管有效，但存在出血风险，因此应谨慎考虑抗凝治疗，尤其是在有晚期 LC 和静脉曲张出血史的患者中。
