Costache Raluca S, Dragomirică Andreea S, Dumitraș Elena A, Mariana Jinga, Căruntu Ana, Popescu Andrada, Costache Daniel O
Department of Gastroenterology, 'Carol Davila' University Central Emergency Military Hospital, 010825 Bucharest, Romania.
5th Clinical Department, Gastroenterology and Internal Medicine Discipline, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Exp Ther Med. 2021 Jul;22(1):759. doi: 10.3892/etm.2021.10191. Epub 2021 May 13.
Portal vein thrombosis (PVT) is a frequent complication in cirrhotic patients, but it may also exist as a basic vascular condition even without any liver damage. Local and systemic factors play a significant role in the pathogenesis of PVT; yet, in practice, more than one factor may be identified. PVT can be considered a result of liver fibrosis and hepatic insufficiency. The mutation has been accepted as a factor producing PVT. In general, the anticoagulants are recommended but this therapy should be used carefully in treating patients that associate coagulopathy or thrombocytopenia and esophageal varices. Acute PVT without bowel infarction has a good prognosis. In liver cirrhosis, the mortality due to hemorrhage is higher than in chronic PVT. Therefore, for the patients with PVT, the survival rate is decreased by 55% in two years, due to hepatic insufficiency. Regarding the treatment, LMWH (low molecular weight heparine) is the most utilized in patients with cirrhosis, non-malignancies, infections, or those who are awaiting a liver transplant. DOACs (direct-acting oral anticoagulants) may be used in the rest of the medical conditions, being safe and equal to LMWH.
门静脉血栓形成（PVT）是肝硬化患者常见的并发症，但即使没有任何肝脏损伤，它也可能作为一种基本的血管疾病存在。局部和全身因素在PVT的发病机制中起重要作用；然而，在实际情况中，可能会发现不止一个因素。PVT可被认为是肝纤维化和肝功能不全的结果。该突变已被公认为导致PVT的一个因素。一般来说，推荐使用抗凝剂，但在治疗合并凝血功能障碍或血小板减少症以及食管静脉曲张的患者时，应谨慎使用这种疗法。无肠梗死的急性PVT预后良好。在肝硬化中，出血导致的死亡率高于慢性PVT。因此，对于PVT患者，由于肝功能不全，两年内生存率降低55%。关于治疗，低分子量肝素（LMWH）在肝硬化、非恶性肿瘤、感染患者或等待肝移植的患者中使用最为广泛。直接口服抗凝剂（DOACs）可用于其他医疗情况，其安全性与LMWH相当。
