Department of Gastroenterology & Hepatology, University Hospital of Heraklion, Heraklion, Crete, Greece -
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
Minerva Gastroenterol (Torino). 2023 Mar;69(1):107-113. doi: 10.23736/S2724-5985.21.02861-8.
Portal vein thrombosis (PVT) is a common complication of cirrhosis and can be a cause or consequence of liver disease progression. It is unclear whether PVT treatment is affecting clinical outcomes in cirrhotics.
This is a multicenter study of cirrhotics with PVT, initially retrospectively and thereafter prospectively registered in a data base. We studied the impact of PVT treatment on this population for efficacy, safety and the impact on survival. In survival analysis Mantel-Cox and Wilcoxon-Breslow-Gehan tests were used. A P value of <0.05, was considered significant. For statistical computations the STATA 12.1 was used.
Seventy-six patients were included (76% decompensated, median MELD score 12 and Child-Pugh score 7), 47% with concomitant HCC. Fifty-one patients with PVT were treated with Vitamin-K antagonists or Low-Molecular-Weight Heparin. Patients were followed up for at least 6 months after PVT diagnosis, or until death or transplantation. PV patency after 6 months was not statistically different between patients receiving or not anticoagulation (complete-partial recanalization 27.4% of treated vs. 20% of untreated, P=0.21). Median survival was statistically worse between patients treated with anticoagulation than those untreated (10 vs. 15 months, P=0.036). Less portal hypertensive bleeding and less decompensation rates were found in treated cirrhotics vs. untreated (45.8% vs. 54.2%, P=0.003 and 78% vs. 80.9%, P=0.78, respectively). Patients with HCC had worse survival when treated vs. untreated (P=0.047).
In our cohort of cirrhotics with PVT, treatment was feasible with acceptable side effects, but without meaningful clinical benefits.
门静脉血栓形成（PVT）是肝硬化的常见并发症，可能是肝病进展的原因或后果。目前尚不清楚 PVT 的治疗是否会影响肝硬化患者的临床结局。
这是一项多中心研究，纳入了最初回顾性、此后前瞻性注册在数据库中的肝硬化合并 PVT 患者。我们研究了 PVT 治疗对该人群的疗效、安全性和对生存的影响。在生存分析中，使用了 Mantel-Cox 和 Wilcoxon-Breslow-Gehan 检验。P 值<0.05 被认为有统计学意义。统计计算使用了 STATA 12.1。
共纳入 76 例患者（76%为失代偿期，中位 MELD 评分 12 分，Child-Pugh 评分 7 分），47%合并 HCC。51 例 PVT 患者接受维生素 K 拮抗剂或低分子肝素治疗。患者在 PVT 诊断后至少随访 6 个月，或直至死亡或移植。6 个月后，抗凝治疗与未抗凝治疗患者的 PV 再通率无统计学差异（完全/部分再通率分别为 27.4%和 20%，P=0.21）。抗凝治疗组患者的中位生存时间明显短于未抗凝治疗组（10 个月 vs. 15 个月，P=0.036）。与未抗凝治疗组相比，抗凝治疗组患者的门静脉高压性出血和肝功能失代偿发生率更低（45.8% vs. 54.2%，P=0.003 和 78% vs. 80.9%，P=0.78）。与未抗凝治疗组相比，接受治疗的 HCC 患者的生存时间更差（P=0.047）。
在我们的肝硬化合并 PVT 患者队列中，治疗是可行的，副作用可接受，但没有明显的临床获益。
