Anticoagulation Therapy Prevents Portal-splenic Vein Thrombosis After Splenectomy with Gastroesophageal Devascularization

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2012 Jul 19

PMID 22807615

Citations 19

Authors

Wei Lai

Shi-Chun Lu

Guan-Yin Li

Chuan-Yun Li

Ju-Shan Wu

Qing-Liang Guo

Meng-Long Wang

Ning Li

Affiliations

Soon will be listed here.

Abstract

Aim: To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.

Methods: We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.

Results: The patients' data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.

Conclusion: Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Citing Articles

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Wang J, Li J, Wang W, Lv X, Zhu R, Yuan T Surg Endosc. 2023; 38(2):648-658.

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Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization.

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Evaluation of the risk factors for venous thromboembolism post splenectomy - A ten year retrospective cohort study in St James's hospital.

Abduljalil M, Saunders J, Doherty D, Dicks M, Maher C, Mehigan B Ann Med Surg (Lond). 2021; 66:102381.

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Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial.

Yao W, Feng Y, Liu T, Li W, Zhang M, Yao Y EXCLI J. 2021; 20:537-549.

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Splanchnic Vein Thrombosis in Liver Cirrhosis After Splenectomy or Splenic Artery Embolization: A Systematic Review and Meta-Analysis.

Wu Y, Li H, Zhang T, Bai Z, Xu X, Levi Sandri G Adv Ther. 2021; 38(4):1904-1930.

PMID: 33687650 DOI: 10.1007/s12325-021-01652-7.

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