新型口服抗凝剂在伴或不伴肝硬化患者急性门静脉血栓形成治疗中的应用
Newer Oral Anticoagulants in the Treatment of Acute Portal Vein Thrombosis in Patients with and without Cirrhosis.
作者信息
Priyanka P, Kupec J T, Krafft M, Shah N A, Reynolds G J
机构信息
Department of Medicine, West Virginia University Hospitals, Morgantown, WV, USA.
Department of Medicine, Section of Digestive Diseases, West Virginia University Hospitals, Morgantown, WV, USA.
出版信息
Int J Hepatol. 2018 Jun 5;2018:8432781. doi: 10.1155/2018/8432781. eCollection 2018.
BACKGROUND
Newer oral anticoagulants (NOACs) are being utilized increasingly for the treatment of venous thromboembolism (VTE). NOAC use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute VTE involving extremities and pulmonary embolism. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis (PVT) with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Literature evaluating NOAC use in the treatment of acute portal vein thrombosis is sparse. This review focuses on the safety and efficacy of the use of NOACs in the treatment of acute PVT in patients, with or without concomitant cirrhosis, based on the most recent data available in the current literature.
METHODS
A systematic review was conducted through a series of advanced searches in the following medical databases: PubMed, BioMed Central, Cochrane, and Google Scholar. Keywords utilized were as follows: NOAC, DOAC (direct oral anticoagulants), portal vein thrombosis, rivaroxaban, apixaban, dabigatran, and edoxaban. Articles related to newer anticoagulant use in patients with portal vein thrombosis were included.
RESULTS
The adverse events, including bleeding events (major and minor) and the failure of anticoagulation (propagation of thrombus or recurrence of PVT), are similar between the NOACs and traditional anticoagulants for the treatment of acute PVT, irrespective of the presence of cirrhosis.
CONCLUSIONS
Newer oral anticoagulants are safe and efficacious alternatives to traditional anticoagulation with low molecular weight heparin and vitamin K antagonists in the treatment of acute portal vein thrombosis with or without cirrhosis.
背景
新型口服抗凝药（NOACs）越来越多地用于治疗静脉血栓栓塞症（VTE）。在非瓣膜性心房颤动的卒中预防以及涉及四肢和肺栓塞的急性VTE治疗中，使用NOAC是标准治疗方法。相比之下，文献中的大多数指南支持用低分子量肝素（LMWH）和维生素K拮抗剂（VKA）治疗急性门静脉血栓形成（PVT）。评估NOAC用于治疗急性门静脉血栓形成的文献很少。本综述基于当前文献中的最新数据，重点探讨了NOAC在治疗伴有或不伴有肝硬化的急性PVT患者中的安全性和有效性。
方法
通过在以下医学数据库中进行一系列高级检索开展系统综述：PubMed、BioMed Central、Cochrane和谷歌学术。使用的关键词如下：NOAC、DOAC（直接口服抗凝药）、门静脉血栓形成、利伐沙班、阿哌沙班、达比加群和依度沙班。纳入了与门静脉血栓形成患者使用新型抗凝药相关的文章。
结果
在治疗急性PVT时，无论是否存在肝硬化，NOAC与传统抗凝药相比，不良事件（包括大出血和小出血事件）以及抗凝失败（血栓扩展或PVT复发）情况相似。
结论
在治疗伴有或不伴有肝硬化的急性门静脉血栓形成时，新型口服抗凝药是低分子量肝素和维生素K拮抗剂传统抗凝治疗的安全有效替代方案。
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