Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.
PLoS One. 2023 Aug 15;18(8):e0290164. doi: 10.1371/journal.pone.0290164. eCollection 2023.
The aim of this study was to evaluate the efficacy and safety of the anticoagulants for the prevention of portal vein system thrombosis (PVST) in patients with cirrhosis after splenectomy and explore the optimal time of anticoagulant administration.
A systematic literature search was performed using PubMed, Embase and China Biology Medicine disc (CBM)databases, so as to screen out studies comparing the prognoses between cirrhotic post-splenectomy patients treated with and without anticoagulants. The parameters that were analyzed included the incidence of PVST and postoperative bleeding.
With a total of 592 subjects, we included 8 studies (6 observational and 2 randomized trials) that fulfilled the inclusion criteria. We found that the incidence of PVST was significantly lower in the anticoagulation group during the first 6 months of anticoagulant administration. And the largest difference in the incidence of PVST between the anticoagulation and control groups was observed at 3 months (odds ratio 0.17(0.110.27); P = 0.767; I2 = 0.0%) and 6 months (OR = 0.21(0.110.40); P = 0.714; I2 = 0.0%) postoperatively. The incidence of bleeding was not significantly higher in the anticoagulation group (odds ratio 0.71 (0.30~1.71); P = 0.580; I2 = 0.0%).
Low-molecular weight heparin (LMWH) and warfarin can decrease the incidence of PVST in post-splenectomy cirrhotic patients without an increased risk of bleeding. And the optimal use time of warfarin is 6 months after splenectomy.
本研究旨在评估抗凝剂在预防脾切除术后肝硬化患者门静脉系统血栓形成（PVST）中的疗效和安全性，并探讨抗凝剂给药的最佳时间。
系统检索 PubMed、Embase 和中国生物医学文献数据库（CBM），以筛选出比较抗凝治疗与未抗凝治疗的肝硬化脾切除术后患者预后的研究。分析的参数包括 PVST 发生率和术后出血。
共纳入 592 例患者，包括 8 项研究（6 项观察性研究和 2 项随机试验）符合纳入标准。我们发现，在抗凝治疗的前 6 个月内，抗凝组的 PVST 发生率明显较低。抗凝组与对照组在 3 个月（比值比 0.17（0.110.27）；P = 0.767；I² = 0.0%）和 6 个月（OR = 0.21（0.110.40）；P = 0.714；I² = 0.0%）时的 PVST 发生率差异最大。抗凝组出血发生率无显著升高（比值比 0.71（0.30~1.71）；P = 0.580；I² = 0.0%）。
低分子肝素（LMWH）和华法林可降低脾切除术后肝硬化患者的 PVST 发生率，且不会增加出血风险。华法林的最佳使用时间为脾切除术后 6 个月。
