Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

被引：52

作者：

Scheiner, Bernhard ^{[1
,2
]}

Stammet, Paul Rene ^{[1
,2
]}

Pokorny, Sebastian ^{[1
,2
]}

Bucsics, Theresa ^{[1
,2
]}

Schwabl, Philipp ^{[1
,2
]}

Brichta, Andrea ^{[1
]}

Thaler, Johannes ^{[3
]}

Lampichler, Katharina ^{[4
]}

Ba-Ssalamah, Ahmed ^{[4
]}

Ay, Cihan ^{[3
]}

Ferlitsch, Arnulf ^{[1
,2
]}

Trauner, Michael ^{[1
,2
]}

Mandorfer, Mattias ^{[1
,2
]}

Reiberger, Thomas ^{[1
,2
]}

机构：

[1] Med Univ Vienna, Dept Internal Med 3, Div Gastroenterol & Hepatol, Vienna Hepat Hemodynam Lab, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[2] Med Univ Vienna, Vienna Hepat Hemodynam Lab, Vienna, Austria

[3] Med Univ Vienna, Dept Med 1, Clin Div Hematol & Hemostaseol, Vienna, Austria

[4] Med Univ Vienna, Dept Radiol, Vienna, Austria

来源：

WIENER KLINISCHE WOCHENSCHRIFT | 2018年 / 130卷 / 13-14期

关键词：

Liver diseases; Portal vein; Venous thrombosis; Anticoagulants; LIVER-DISEASE; PROGNOSTIC INDICATORS; DECOMPENSATED CIRRHOSIS; CONSENSUS WORKSHOP; ENOXAPARIN; SURVIVAL; HYPERTENSION; EFFICACY; THERAPY; RISK;

D O I：

10.1007/s00508-018-1351-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Non-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis. We retrospectively assessed the course of non-malignant PVT in patients receiving AC. Parameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented. Among 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (ae9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; paEuro= 0.08) and lower progression rates of 25% (vs. 42% without AC; paEuro= 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (naEuro= 39), long-term AC (naEuro= 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, paEuro= 0.031). Interestingly, AST/ALT tended to decrease (-19%/-16%) and the proportion of patients with ascites became lower (-33%) with long-term AC (without AC: +/- 0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6aEurog/dl) when compared to patients without long-term AC (-2%/-0.8aEurog/dl; paEuro= 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%). Our findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.

引用

页码：446 / 455

页数：10

共 26 条

[1] Safety and Efficacy of Anticoagulation Therapy With Low Molecular Weight Heparin for Portal Vein Thrombosis in Patients With Liver Cirrhosis [J].