抗凝血剂改善肝硬化相关门静脉血栓形成的结果

StephenW

Anticoagulants improve outcomes in cirrhosis-related portal vein thrombosis

Pettinari I, et al. Am J Gastroenterol. 2018;doi:10.1038/s41395-018-0421-0.
December 11, 2018

Anticoagulant treatment safely and effectively led to partial or complete recanalization of the portal venous system in more than half of patients with cirrhosis, according to recently published study results.

“Portal vein thrombosis (PVT) is a frequent complication in patients with cirrhosis, although it may often remain asymptomatic, at least early after onset,” I. Pettinari, MD, PhD, from the University of Bologna in Italy, and colleagues wrote. “However, PVT is usually associated with some major clinical complications, including worsening of portal hypertension and liver function, and an increased risk of suffering from varices and gastrointestinal bleeding.”

To explore the safety of anticoagulant treatment for PVT, Pettinari and colleagues retrospectively reviewed the data of 81 patients with cirrhosis-related PVT who received anticoagulant therapy and 101 patients who received no anticoagulation.

Forty-six patients who received anticoagulation achieved recanalization after a median of 5 months, 31 of whom achieved complete recanalization and 15 achieved partial recanalization. The rate of recanalization was significantly higher among those who received anticoagulation compared with the untreated group (56.8% vs. 25.7%; P < .0001).

Seventeen treated patients who achieved recanalization experienced recurrence of PVT after discontinuing anticoagulant therapy.

The researchers observed no significant difference in the rate of bleeding complication or any deaths within 30 days of bleeding events between the two groups.

“In agreement with the current literature, the present study has shown that individualized anticoagulant therapy in cirrhotic patients with PVT is safe as bleeding events do not occur at higher rates than in untreated patients, and the hemorrhagic complications are seldom ascribed to the anticoagulant therapy itself,” the researchers wrote.

Treatment with anticoagulant therapy demonstrated a significantly higher cumulative survival rate compared with the untreated group (P = .01). Additionally, more untreated patients required liver transplantation following PVT diagnosis (17.8% vs. 7.4%; P = .0476).

“Portal vein thrombosis is a frequent complication in liver cirrhosis but its natural history as well as therapeutic management have not yet been clearly addressed by either international guidelines or consensus conferences,” Pettinari and colleagues concluded. “The present study confirmed that recanalization of PVT may occur spontaneously, but it is significantly favored by anticoagulant treatment.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

抗凝血剂改善肝硬化相关门静脉血栓形成的结果

Pettinari I，et al。 Am J Gastroenterol。 2018; DOI：10.1038 / s41395-018-0421-0。
2018年12月11日

根据最近发表的研究结果，超过一半的肝硬化患者安全有效地进行抗凝治疗导致门静脉系统部分或完全再通。

“门静脉血栓形成（PVT）是肝硬化患者的一种常见并发症，尽管它可能通常在发病后至少早期保持无症状，”来自意大利博洛尼亚大学的I. Pettinari博士及其同事写道。 “然而，PVT通常与一些主要的临床并发症有关，包括门静脉高压症和肝功能恶化，以及患静脉曲张和胃肠道出血的风险增加。”

为了探讨PVT抗凝治疗的安全性，Pettinari及其同事回顾性分析了81例接受抗凝治疗的肝硬化相关PVT患者和101例未接受抗凝治疗的患者的数据。

46例接受抗凝治疗的患者在中位数5个月后实现再通，其中31例实现完全再通，15例实现部分再通。接受抗凝治疗的患者再通率明显高于未治疗组（56.8％vs。25.7％; P <.0001）。

在停止抗凝治疗后，17名接受再通的患者出现PVT复发。

研究人员观察到，两组出血事件发生后30天内出血并发症发生率或死亡率无显着差异。

“与目前的文献一致，本研究表明，PVT肝硬化患者的个体化抗凝治疗是安全的，因为出血事件的发生率不高于未治疗患者，出血性并发症很少归因于抗凝治疗本身，“研究人员写道。

与未治疗组相比，抗凝治疗显示累积生存率显着提高（P = .01）。此外，更多未经治疗的患者在PVT诊断后需要进行肝移植（17.8％对7.4％; P = 0.0476）。

“门静脉血栓形成是肝硬化的常见并发症，但其自然病史和治疗管理尚未得到国际指南或共识会议的明确解决，”Pettinari及其同事总结道。 “目前的研究证实，PVT再通可能是自发性的，但抗凝治疗显着受到青睐。” - 作者：Talitha Bennett

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