Khan Fahmi Yousef, Habas Elmukhtar, Sulaiman Theeb Osama, Hamid Omnia A, Abdalhadi Ahmed, Khalaf Ahmad, Afana Mohammed S, Ali Mohamed Yousif, Baniamer Yahia Zakaria, Kanjo Wael, Muthanna Bassam, Akbar Raza Ali
Department of Medicine, Hamad General Hospital, Doha, Qatar.
Weill Cornell Medical College, Ar-Rayyan, Qatar.
J Clin Med Res. 2022 May;14(5):209-217. doi: 10.14740/jocmr4718. Epub 2022 May 31.
There is a lack of robust epidemiological information on portal vein thrombosis (PVT) in Qatar. This study aimed to describe the risk factors, clinical presentation, diagnosis, and treatment outcomes of PVT in patients with and without liver cirrhosis admitted to Hamad General Hospital.
This retrospective observational study was conducted at Hamad General Hospital, Doha, Qatar. Consecutive patients with PVT between January 1, 2015 and December 31, 2019 were included in this study.
We included 363 cases representing 0.05% of all inpatients admitted to our hospital during the study period. Their mean age was 47.79 ± 14.48 years. There were 258 (71.1%) males and 105 (28.9%) females. Abdominal pain was the most common presenting symptom (160 (44.1%)), while splenomegaly was the most common presenting sign (158 (43.5%)). Liver cirrhosis was the most frequent risk factor for PVT (147 (40.5%)), while no risk factors were identified in 49 (13.5%) patients. Anticoagulant therapy was given to 171/207 (82.6%) patients with acute PVT and 19/156 (12.2%) patients with chronic PVT. The options used for anticoagulation treatment were: low molecular weight heparin (LMWH) or unfractionated heparin alone, LMWH/unfractionated heparin followed by warfarin, and direct-acting oral anticoagulants (rivaroxaban). Out of the 262 patients in whom PVT recanalization was assessed, 43.8% of the cases had recanalization after anticoagulation treatment, while 12.6% of them had spontaneous recanalization without such therapy. A comparison between different anticoagulants used in this study showed no significant difference in the effectiveness of the three regimens used. The 30-day mortality was recorded for 71 patients (19.5%). The major risk factors for 30-day mortality were: age over 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L.
PVT is a rare clinical entity in Qatar with liver cirrhosis being the most common risk factor. Early administration of anticoagulation therapy is associated with a significant recanalization, while age > 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L are independent risk factors for 30-day mortality.
卡塔尔缺乏关于门静脉血栓形成（PVT）的可靠流行病学信息。本研究旨在描述哈马德总医院收治的肝硬化和非肝硬化患者中PVT的危险因素、临床表现、诊断及治疗结果。
本回顾性观察性研究在卡塔尔多哈的哈马德总医院进行。纳入2015年1月1日至2019年12月31日期间连续的PVT患者。
我们纳入了363例病例，占研究期间我院所有住院患者的0.05%。他们的平均年龄为47.79±14.48岁。男性258例（71.1%），女性105例（28.9%）。腹痛是最常见的症状（160例（44.1%）），而脾肿大是最常见的体征（158例（43.5%））。肝硬化是PVT最常见的危险因素（147例（40.5%）），49例（13.5%）患者未发现危险因素。171/207例（82.6%）急性PVT患者和19/156例（12.2%）慢性PVT患者接受了抗凝治疗。抗凝治疗的选择包括：单独使用低分子量肝素（LMWH）或普通肝素、LMWH/普通肝素后接华法林，以及直接口服抗凝剂（利伐沙班）。在评估PVT再通情况的262例患者中，43.8%的病例在抗凝治疗后实现了再通，而12.6%的患者未经此类治疗实现了自发再通。本研究中使用的不同抗凝剂之间的比较显示，所采用的三种方案在有效性方面无显著差异。记录了71例患者（19.5%）的30天死亡率。30天死亡率的主要危险因素包括：年龄超过45岁、男性、肝衰竭、恶性肿瘤以及胆红素>34µmol/L。
在卡塔尔，PVT是一种罕见的临床病症，肝硬化是最常见的危险因素。早期给予抗凝治疗与显著的再通相关，而年龄>45岁、男性、肝衰竭、恶性肿瘤以及胆红素>34µmol/L是30天死亡率的独立危险因素。
