Rodriguez-Castro Kryssia I, Vitale Alessandro, Fadin Mariangela, Shalaby Sarah, Zerbinati Patrizia, Sartori Maria Teresa, Landi Stefano, Pettinari Irene, Piscaglia Fabio, Han Guohong, Burra Patrizia, Simioni Paolo, Senzolo Marco
Departments of Surgery, Oncology and Gastroenterology, Multivisceral Transplant Unit.
Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit.
Eur J Gastroenterol Hepatol. 2019 Jan;31(1):34-42. doi: 10.1097/MEG.0000000000001237.
Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics.
Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled. All patients underwent evaluation of coagulation status and thrombophilia screening. Thrombus characteristics and extension were evaluated at baseline and during follow-up. Anticoagulation was continued until recanalization or up to 12 months. Variables correlated with the response to anticoagulation were used to create a predictive score that was validated in an external multicenter cohort.
A total of 65 patients were included and had partial PVT in most cases (72%). Treatment with enoxaparin resulted in an overall response rate of 66% (43/65) after a median time of 4.4 months and 76% (33/43) within the first 6 months. At multivariate analysis, efficacy of anticoagulation correlated with the severity of liver disease, complete verus partial PVT, age of the thrombus, and time interval from treatment start (<6 months). The areas under the curve of the statistical model for predicting the response to anticoagulation were 0.84 and 0.76 for the training (n=65) and validation (n=60) cohorts, respectively.
Early diagnosis and early treatment are key factors for the successful management of PVT in cirrhosis, so that screening of PVT and prompt start of anticoagulant treatment should be mandatory.
门静脉血栓形成（PVT）是肝硬化常见的并发症，一旦血栓完全形成，会增加肝移植候选者的发病率和死亡率。本研究旨在评估止血状态以及血栓和患者的临床特征，作为肝硬化患者PVT抗凝治疗疗效的预测指标。
纳入连续接受依诺肝素治疗PVT的肝硬化患者。所有患者均接受凝血状态评估和易栓症筛查。在基线期和随访期间评估血栓特征及扩展情况。抗凝治疗持续至血栓再通或长达12个月。将与抗凝反应相关的变量用于创建一个预测评分，并在外部多中心队列中进行验证。
共纳入65例患者，多数患者（72%）为部分性PVT。依诺肝素治疗的总体缓解率在中位时间4.4个月后为66%（43/65），在前6个月内为76%（33/43）。多因素分析显示，抗凝疗效与肝病严重程度、完全性与部分性PVT、血栓形成时间以及治疗开始后的时间间隔（<6个月）相关。预测抗凝反应的统计模型在训练队列（n = 65）和验证队列（n = 60）中的曲线下面积分别为0.84和0.76。
早期诊断和早期治疗是成功管理肝硬化患者PVT的关键因素，因此PVT筛查和及时启动抗凝治疗应成为强制性措施。
