Zhan Chenyang, Prabhu Vinay, Kang Stella K, Li Clayton, Zhu Yuli, Kim Sooah, Olsen Sonja, Jacobson Ira M, Dagher Nabil N, Carney Brendan, Hickey Ryan M, Taslakian Bedros
Division of Vascular Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA.
Division of Abdominal Imaging, Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA.
J Clin Med. 2021 May 26;10(11):2316. doi: 10.3390/jcm10112316.
There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment.
This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6-9 months) and late follow-up (9-16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded.
The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up ( = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up ( = 0.007). No bleeding complications attributable to anticoagulation were observed.
TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.
肝硬化患者门静脉血栓形成（PVT）的最佳管理缺乏共识。本研究的目的是比较仅接受经颈静脉肝内门体分流术（TIPS）、仅接受抗凝治疗或不接受治疗的非肿瘤性PVT肝硬化患者的安全性和血栓负荷变化。
这项单中心回顾性研究评估了52例肝硬化和非肿瘤性PVT患者，这些患者分别仅接受TIPS治疗（14例）、仅接受抗凝治疗（11例）或不接受治疗（27例）。收集患者的人口统计学、临床和影像学数据。将早期随访（6 - 9个月）和晚期随访（9 - 16个月）时的门静脉肠系膜血栓负荷和肝功能检查结果与基线进行比较。记录包括出血和脑病在内的不良事件。
早期随访时，8例（72%）接受TIPS治疗的患者、3例（27%）接受抗凝治疗的患者和2例（10%）未治疗的患者门静脉肠系膜血栓总体负荷有所改善（P = 0.001）；晚期随访时，7例（78%）接受TIPS治疗的患者、2例（29%）接受抗凝治疗的患者和3例（17%）未治疗的患者门静脉肠系膜血栓总体负荷有所改善（P = 0.007）。未观察到归因于抗凝治疗的出血并发症。
对于患有PVT的肝硬化患者，与抗凝治疗或不治疗相比，TIPS降低了门静脉肠系膜血栓负荷。TIPS和抗凝治疗都是安全的治疗方法。
