Artaza Tomas, Lopes Miriam, Romero Marta, Gómez Ana-Zaida, de la Cruz Gema, Sánchez Juan José, González Concepción, Gómez Rafael
Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain.
Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain.
Gastroenterol Hepatol. 2018 Dec;41(10):611-617. doi: 10.1016/j.gastrohep.2018.06.005. Epub 2018 Jul 24.
Treatment for portal vein thrombosis (PVT) is not well established. Nevertheless, anticoagulation therapy can seemingly be used as first-line therapy. However, there are limited data on the role of this treatment in patients with PVT and cirrhosis. We sought to assess the safety and efficacy of anticoagulation therapy in a series of patients with non-malignant PVT and liver cirrhosis.
We analyzed the data of 32 patients with cirrhosis and PVT between March 2009 and September 2015. All patients received anticoagulation treatment. PVT was diagnosed within the context of biannual hepatocellular carcinoma screening in these patients.
Recanalisation was achieved in 23 patients: complete in 17 patients (53.1%) and partial in 6 patients (18.7%). The median time for achieving a complete response was 7 months (95% CI: 6-8). We did not discover any risk factors associated with repermeation (partial or complete). None of the patients presented with thrombosis progression while receiving anticoagulation. Nine patients who achieved complete recanalisation and stopped anticoagulation therapy suffered rethrombosis (52%). There were no differences between the patients who achieved complete or partial recanalisation (35%) and those who did not (33%) in relation to the onset of hepatic events during follow-up. Three patients (9%) presented with bleeding complications: two variceal bleeding episodes and one brain hemorrhage.
In cirrhotic patients with non-malignant PVT, anticoagulation therapy led to partial or complete recanalisation in 70% of patients, with a broad safety profile. Due to the existing rethrombosis rate, long-term anticoagulation should be considered.
门静脉血栓形成（PVT）的治疗方法尚未完全确立。尽管如此，抗凝治疗似乎可作为一线治疗方法。然而，关于这种治疗方法在PVT合并肝硬化患者中的作用的数据有限。我们试图评估抗凝治疗在一系列非恶性PVT合并肝硬化患者中的安全性和有效性。
我们分析了2009年3月至2015年9月期间32例肝硬化合并PVT患者的数据。所有患者均接受抗凝治疗。这些患者在每半年一次的肝细胞癌筛查中被诊断为PVT。
23例患者实现了再通：17例完全再通（53.1%），6例部分再通（18.7%）。实现完全缓解的中位时间为7个月（95%CI：6-8）。我们未发现与再通（部分或完全）相关的任何危险因素。在接受抗凝治疗期间，没有患者出现血栓进展。9例实现完全再通并停止抗凝治疗的患者发生了再血栓形成（52%）。在随访期间，实现完全或部分再通的患者（35%）与未实现再通的患者（33%）在肝脏事件的发生方面没有差异。3例患者（9%）出现出血并发症：2例静脉曲张出血发作和1例脑出血。
在非恶性PVT合并肝硬化的患者中，抗凝治疗使70%的患者实现了部分或完全再通，安全性良好。鉴于存在再血栓形成率，应考虑长期抗凝。
