Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal.
Serviço De Imagiologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Dig Dis Sci. 2019 Sep;64(9):2671-2683. doi: 10.1007/s10620-019-05572-z. Epub 2019 Mar 9.
The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial.
We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival.
Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis.
Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p = 0.005]. OLT-free survival after a median follow-up of 25 (1-146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not (p = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01-1.21, p = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05-1.19, p < 0.001).
Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.
门静脉血栓形成（PVT）在肝硬化自然病程中的作用仍存在争议。
我们分析抗凝治疗（AT）对 PVT 再通和肝移植（OLT）无失败生存率的安全性和效果。
对一家三级中心前瞻性肝硬化和非肿瘤性 PVT 登记处的 80 例连续患者进行分析。采用时间依赖性 Cox 回归分析确定 AT 对 PVT 再通和 OLT 无失败生存率的影响。
平均 MELD 评分为 15±7。PVT 诊断时存在与门脉高压相关的并发症的患者为 65 例（81.3%）。孤立的门静脉主干/分支血栓形成的患者为 53 例（66.3%）。37 例患者开始接受 AT。17 例（45.9%）患者因出血事件停止 AT，4 例（10.8%）患者因出血事件停止 AT。AT 期间未发生静脉曲张出血。由于再血栓形成，6/17 例（35.2%）患者重新开始抗凝治疗。在 67 例具有充分随访影像学的患者中，与未接受抗凝治疗的患者相比，AT 显著增加了 PVT 再通率[51.4%（18/35）比 6/32（18.8%），p=0.005]。中位随访 25（1-146）个月后，OLT 无失败生存率为 32（40%）。尽管 AT 对总体 OLT 无失败生存率无显著影响，但 MELD≥15 的患者接受 AT 治疗的 OLT 无失败生存率高于未接受治疗的患者（p=0.011）。PVT 检出时的基线 MELD 独立预测 PVT 再通（HR 1.11，95%CI 1.01-1.21，p=0.027）和死亡率/OLT（HR 1.12，95%CI 1.05-1.19，p<0.001）。
尽管 AT 并未改善总体 OLT 无失败生存率，但在晚期肝硬化中与更高的生存率相关。抗凝治疗增加了 PVT 再通，PVT 再通后应维持抗凝治疗以避免再血栓形成。
