Division of Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America.
Division of Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America.
Thromb Res. 2022 Aug;216:1-7. doi: 10.1016/j.thromres.2022.05.012. Epub 2022 May 27.
Splanchnic vein thrombosis (SVT) occurs in a heterogenous group of patients secondary to a variety of risk factors including liver disease. Minimal data regarding natural history and outcomes of SVT exists to inform management decisions. As such, there is equipoise regarding the utility of anticoagulation in cirrhotic patients with SVT. We sought to identify clinical factors predictive of new or progressive thrombosis in a cohort of patients with untreated SVT.
We conducted a retrospective cohort study of cirrhotic patients over 18 years of age diagnosed with SVT at the Oregon Health & Science University from 2015 to 2020, excluding those initially treated with anticoagulation. The primary study endpoint was a composite of the following: imaging-confirmed progression of SVT, development of cavernous transformation, intestinal ischemia, portal cholangiopathy or new venous or arterial thrombosis.
261 patients were included in the analysis (median age 61 years, 68% male, 32% female). Forty percent of all patients experienced the primary composite endpoint. Multivariable logistic regression found that only the presence of pancreatitis or abdominal infection at diagnosis was associated with an increased likelihood of experiencing thrombus progression in patients with untreated SVT (OR 3.61, P = 0.02). There was a statistically significant overall survival difference between patients that did and did not experience the primary composite endpoint after controlling for confounding variables. (p = 0.0068).
Overall, only the presence of pancreatitis or intrabdominal infection were found to be significantly associated with thrombotic progression, with varices identified as marginally non-significant risk factor. Notably, thrombotic progression was associated with a significant reduction in overall survival.
内脏静脉血栓形成（SVT）发生于多种不同风险因素导致的异质性患者群体中，包括肝脏疾病。目前，关于 SVT 的自然史和结局的数据很少，无法为管理决策提供信息。因此，对于伴有 SVT 的肝硬化患者，抗凝治疗的效用存在争议。我们旨在确定未经治疗的 SVT 患者队列中新发或进展性血栓形成的临床预测因素。
我们对俄勒冈健康与科学大学 2015 年至 2020 年间诊断为 SVT 的年龄超过 18 岁的肝硬化患者进行了回顾性队列研究，排除了最初接受抗凝治疗的患者。主要研究终点是以下各项的综合结果：影像学证实的 SVT 进展、海绵状转化、肠缺血、门脉胆管病或新的静脉或动脉血栓形成。
共纳入 261 例患者（中位年龄 61 岁，68%为男性，32%为女性）。所有患者中有 40%经历了主要复合终点。多变量逻辑回归发现，仅在诊断时存在胰腺炎或腹部感染的患者，与未经治疗的 SVT 患者发生血栓进展的可能性增加相关（OR 3.61，P=0.02）。在控制混杂因素后，经历主要复合终点的患者与未经历该终点的患者之间的总体生存率存在统计学显著差异（p=0.0068）。
总体而言，仅胰腺炎或腹腔内感染的存在与血栓进展显著相关，静脉曲张被确定为具有边缘统计学意义的风险因素。值得注意的是，血栓进展与总体生存率的显著降低相关。
