Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension
Abstract Aims Splenectomy combined with pericardial devascularization is one of the important methods to treat hypersplenism, gastrointestinal bleeding, and other complications caused by liver cirrhosis; however, it is accompanied by a high risk of portal vein thrombosis (PVT). This study aimed to e...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-09-01
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| Series: | Portal Hypertension & Cirrhosis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/poh2.58 |
| _version_ | 1797670750175363072 |
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| author | Yang Bu Kejun Liu Mingguo Tian Baoding Li Liyun Wang Dong Jia Yong Yang Junhao Liu |
| author_facet | Yang Bu Kejun Liu Mingguo Tian Baoding Li Liyun Wang Dong Jia Yong Yang Junhao Liu |
| author_sort | Yang Bu |
| collection | DOAJ |
| description | Abstract Aims Splenectomy combined with pericardial devascularization is one of the important methods to treat hypersplenism, gastrointestinal bleeding, and other complications caused by liver cirrhosis; however, it is accompanied by a high risk of portal vein thrombosis (PVT). This study aimed to explore the preventive and therapeutic effects of proximal splenic vein ligation (PSVL) with postoperative transcatheter anticoagulant therapy (TCAT) on PVT. Methods This study retrospectively selected 143 patients with liver cirrhosis and portal hypertension, who received splenectomy combined with pericardial devascularization from June 30, 2018 to June 30, 2021. According to computed tomography photography, within 1 week before the operation, the patients were divided into a prevention group (without preoperative PVT, n = 112) and a treatment group (preoperative PVT, n = 31). Then, each group was subdivided based on the treatment and prevention measures into PSVL + TCAT (n = 70) and systemic anticoagulant therapy (SAT) subgroups (n = 73). The preventive and therapeutic effects of PSVL followed by TCAT on PVT were analyzed. Results The operation time in the PSVL + TCAT subgroups was longer than that in the SAT subgroups (185 ± 76 min vs. 161 ± 55 min; p < 0.01). There was no difference between the two subgroups in terms of operative bleeding (345 ± 82 mL vs. 336 ± 65 mL; p > 0.50). There was no operative death, and all patients recovered uneventfully. In the prevention group, procedure‐related complications occurred in two patients in the PSVL + TCAT subgroup (3.7% [2/54]), including one patient with slight pancreatitis and one patient with chylous leakage, owing to mobilization of the pancreas. The PVT incidence in the prevention group was significantly different between the two subgroups at postoperative 7th day, 3rd month, and 6th month (PSVL + TCAT: 0%, 11.1%, and 5.6% vs. SAT: 39.7%, 31.0%, and 20.7%, respectively; all p < 0.05). In the treatment group, the thrombus regression rate at postoperative 7th day and disappearance rates at the 3rd month and the 6th month of the PSVL + TCAT subgroup were significantly higher than those in the SAT subgroup after anticoagulant and thrombolysis therapy (PSVL + TCAT: 75.0%, 68.8%, and 87.5% vs. SAT: 20.0%, 26.7%, and 40.0%; all p < 0.05). Conclusions PSVL + TCAT reduces the risk of PVT after splenectomy and is safe and effective in treating PVT during surgery for portal hypertension. |
| first_indexed | 2024-03-11T21:04:05Z |
| format | Article |
| id | doaj.art-e1813f1874104c32ad4386c4c832f62d |
| institution | Directory Open Access Journal |
| issn | 2770-5846 |
| language | English |
| last_indexed | 2024-03-11T21:04:05Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Portal Hypertension & Cirrhosis |
| spelling | doaj.art-e1813f1874104c32ad4386c4c832f62d2023-09-29T15:18:36ZengWileyPortal Hypertension & Cirrhosis2770-58462023-09-012313614310.1002/poh2.58Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertensionYang Bu0Kejun Liu1Mingguo Tian2Baoding Li3Liyun Wang4Dong Jia5Yong Yang6Junhao Liu7Department of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery General Hospital of Ningxia Medical University Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaDepartment of Hepatobiliary Surgery People's Hospital of Ningxia Hui Autonomous Region Yinchuan Ningxia ChinaAbstract Aims Splenectomy combined with pericardial devascularization is one of the important methods to treat hypersplenism, gastrointestinal bleeding, and other complications caused by liver cirrhosis; however, it is accompanied by a high risk of portal vein thrombosis (PVT). This study aimed to explore the preventive and therapeutic effects of proximal splenic vein ligation (PSVL) with postoperative transcatheter anticoagulant therapy (TCAT) on PVT. Methods This study retrospectively selected 143 patients with liver cirrhosis and portal hypertension, who received splenectomy combined with pericardial devascularization from June 30, 2018 to June 30, 2021. According to computed tomography photography, within 1 week before the operation, the patients were divided into a prevention group (without preoperative PVT, n = 112) and a treatment group (preoperative PVT, n = 31). Then, each group was subdivided based on the treatment and prevention measures into PSVL + TCAT (n = 70) and systemic anticoagulant therapy (SAT) subgroups (n = 73). The preventive and therapeutic effects of PSVL followed by TCAT on PVT were analyzed. Results The operation time in the PSVL + TCAT subgroups was longer than that in the SAT subgroups (185 ± 76 min vs. 161 ± 55 min; p < 0.01). There was no difference between the two subgroups in terms of operative bleeding (345 ± 82 mL vs. 336 ± 65 mL; p > 0.50). There was no operative death, and all patients recovered uneventfully. In the prevention group, procedure‐related complications occurred in two patients in the PSVL + TCAT subgroup (3.7% [2/54]), including one patient with slight pancreatitis and one patient with chylous leakage, owing to mobilization of the pancreas. The PVT incidence in the prevention group was significantly different between the two subgroups at postoperative 7th day, 3rd month, and 6th month (PSVL + TCAT: 0%, 11.1%, and 5.6% vs. SAT: 39.7%, 31.0%, and 20.7%, respectively; all p < 0.05). In the treatment group, the thrombus regression rate at postoperative 7th day and disappearance rates at the 3rd month and the 6th month of the PSVL + TCAT subgroup were significantly higher than those in the SAT subgroup after anticoagulant and thrombolysis therapy (PSVL + TCAT: 75.0%, 68.8%, and 87.5% vs. SAT: 20.0%, 26.7%, and 40.0%; all p < 0.05). Conclusions PSVL + TCAT reduces the risk of PVT after splenectomy and is safe and effective in treating PVT during surgery for portal hypertension.https://doi.org/10.1002/poh2.58hypertensionportalpreventionsplenectomyvenous thrombosis |
| spellingShingle | Yang Bu Kejun Liu Mingguo Tian Baoding Li Liyun Wang Dong Jia Yong Yang Junhao Liu Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension Portal Hypertension & Cirrhosis hypertension portal prevention splenectomy venous thrombosis |
| title | Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| title_full | Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| title_fullStr | Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| title_full_unstemmed | Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| title_short | Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| title_sort | comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension |
| topic | hypertension portal prevention splenectomy venous thrombosis |
| url | https://doi.org/10.1002/poh2.58 |
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