Xia Y F, Song A C, Wang A J, Huang C Q, Zhang Chunqing
Department of Gastroenterology of Shandong Provincial Hospital, Shandong University, Jinan 250021, China.
the Affiliated Weihai Second Municipal Hospital of Qingdao University, Qingdao 266000, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Jul 20;30(7):728-734. doi: 10.3760/cma.j.cn501113-20210106-00010.
To explore the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt. The basic information, laboratory test results, preoperative portal venous pressure, postoperative anticoagulation time, postoperative stent stenosis or occlusion, followed-up and other data of all patients who underwent TIPS surgery in Shandong Provincial Hospital from 2010 to 2019 were retrospectively analyzed. Data were analyzed using t-test, test, and multivariate analysis (logistic regression and Cox-regression-analysis). A total of 280 cases were finally included in the study, of which 110 (39.3%) had stent stenosis or occlusion, and 170 (60.7%) had stent patency. New or worsening ascites were identified in 194 cases during the follow-up period, including 14 (31.1%) cases in the stent stenosis or occlusion group and 19 (12.8%) cases in the stent patency group. Univariate analysis showed that presence or absence of platelet (=0.037) and total bilirubin (=0.038) were correlated with stent stenosis or occlusion. Postoperative continuous anticoagulation was correlated with stent blockage (=0.029) in patients with partial portal vein thrombosis. Postoperative continuous anticoagulation and stent occlusions were not significantly correlated in patients with preoperative portal cavernoma and preoperative portal vein patency (=0.848; =0.744). Multivariate analysis results showed that whether long-term anticoagulation (=0.017), all-cause rebleeding (<0.001), postoperative significant hepatic encephalopathy (<0.012), and postoperative new or worsening ascites (<0.001) was significantly associated with stent occlusion (<0.05), while platelets (=0.134), total bilirubin (=0.229), international normalized ratio (=0.436), and portal vein pressure (=0.230) were not significantly associated with stent occlusion after surgery. In patients with partial portal vein thrombosis before surgery, continuous anticoagulation for 30 days post-TIPS therapy can effectively prevent stent stenosis or occlusion; while in patients with portal vein patency, portal cavernoma and complete portal vein blockage before surgery, postoperative anticoagulation has no significant effect on stent stenosis or occlusion.
探讨经颈静脉肝内门体分流术（TIPS）后抗凝治疗的必要性及支架闭塞的影响因素。回顾性分析2010年至2019年在山东省立医院接受TIPS手术的所有患者的基本信息、实验室检查结果、术前门静脉压力、术后抗凝时间、术后支架狭窄或闭塞情况、随访等数据。采用t检验、检验及多因素分析（逻辑回归和Cox回归分析）进行数据分析。最终共纳入280例患者，其中110例（39.3%）发生支架狭窄或闭塞，170例（60.7%）支架通畅。随访期间194例患者出现新发或加重腹水，其中支架狭窄或闭塞组14例（31.1%），支架通畅组19例（12.8%）。单因素分析显示血小板（=0.037）及总胆红素（=0.038）与支架狭窄或闭塞相关。部分门静脉血栓形成患者术后持续抗凝与支架堵塞相关（=0.029）。术前门静脉海绵样变及术前门静脉通畅患者术后持续抗凝与支架闭塞无显著相关性（=0.848；=0.744）。多因素分析结果显示，长期抗凝与否（=0.017）、全因再出血（<0.001）、术后显著肝性脑病（<0.012）及术后新发或加重腹水（<0.001）与支架闭塞显著相关（<0.05），而血小板（=0.134）、总胆红素（=0.229）、国际标准化比值（=0.436）及门静脉压力（=0.230）与术后支架闭塞无显著相关性。术前部分门静脉血栓形成患者，TIPS治疗后持续抗凝30天可有效预防支架狭窄或闭塞；而术前门静脉通畅、门静脉海绵样变及门静脉完全堵塞患者，术后抗凝对支架狭窄或闭塞无显著影响。
