Sato Ayako, Watanabe Sho, Iseki Mari, Yamada Yurina, Kobayashi Ryohei, Furuya Makoto, Arai Katsuhiro, Ohshina Eri, Tashiro Yoshihiro, Nozaka Takahito, Matsuoka Mana, Yauchi Masato, Kobayashi Katsumasa, Matsumoto Taichi, Furumoto Yohei, Asano Toru, Azuma Seishin
Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Soka Municipal Hospital, Saitama, Japan.
Hepatol Res. 2023 Nov;53(11):1096-1104. doi: 10.1111/hepr.13942. Epub 2023 Jul 22.
Portal vein thrombosis (PVT) is one of the common complications of liver cirrhosis. Although anticoagulation contributes to thrombus resolution and is considered the first-choice treatment, its impact on patients' prognosis is still controversial. This study aimed to clarify the benefit of anticoagulation on mortality, liver function, and the incidence of liver cirrhosis-related complications in cirrhotic PVT patients.
We conducted a multicenter retrospective review in which we included 78 eligible patients with PVT out of 439. After propensity score matching, 21 cirrhotic PVT patients were included in each one of the untreated control and anticoagulation groups.
Overall survival was significantly improved in the anticoagulation group compared with the control group (p = 0.041), along with PVT size reduction (53.3% vs. 108.2%, p = 0.009). At the time of CT follow-up, the anticoagulation group showed a lower ALBI score (p = 0.037) and its prevalence of massive ascites was significantly lower (p = 0.043) compared with the control group. The incidence of overt encephalopathy was also lower in the anticoagulation group (p = 0.041). The cumulative incidence of bleeding events did not differ significantly between the two groups.
Anticoagulation improves the survival of patients with cirrhotic PVT. Preserved liver function and reduced risks of cirrhosis-related complications under the treatment may have contributed to a better prognosis. Given its efficacy and safety, anticoagulation is worth initiating in patients with PVT.
门静脉血栓形成（PVT）是肝硬化常见并发症之一。尽管抗凝治疗有助于血栓溶解，被视为首选治疗方法，但其对患者预后的影响仍存在争议。本研究旨在阐明抗凝治疗对肝硬化合并PVT患者死亡率、肝功能及肝硬化相关并发症发生率的益处。
我们进行了一项多中心回顾性研究，从439例患者中纳入了78例符合条件的PVT患者。经过倾向评分匹配后，未治疗的对照组和抗凝治疗组各纳入21例肝硬化合并PVT患者。
与对照组相比，抗凝治疗组的总生存率显著提高（p = 0.041），同时PVT大小缩小（53.3% 对 108.2%，p = 0.009）。在CT随访时，与对照组相比，抗凝治疗组的ALBI评分更低（p = 0.037），大量腹水的发生率显著更低（p = 0.043）。抗凝治疗组显性脑病的发生率也更低（p = 0.041）。两组出血事件的累积发生率无显著差异。
抗凝治疗可提高肝硬化合并PVT患者的生存率。治疗过程中肝功能的保留及肝硬化相关并发症风险的降低可能有助于改善预后。鉴于其有效性和安全性，抗凝治疗值得在PVT患者中启动。
