A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization

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• 作者：Zhe Cheng ; Fan Yu ; Ju Tian ; Peng Guo ; Jianwei Li&#8230
• 关键词：Portal hypertension ; Splenectomy and esophagogastric devascularization ; Laparoscopy ; Portal vein system thrombosis ; Anti ; coagulant
• 刊名：Journal of Thrombosis and Thrombolysis
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：40
• 期：3
• 页码：294-301
• 全文大小：480 KB
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• 作者单位：Zhe Cheng (1)
  Fan Yu (1)
  Ju Tian (1)
  Peng Guo (1)
  Jianwei Li (1)
  Jian Chen (1)
  Yudong Fan (1)
  Shuguo Zheng (1)
  
  1. Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Gaotanyan Road 29#, Shapingba District, Chongqing, 400038, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Hematology
  
• 出版者：Springer Netherlands
• ISSN：1573-742X

文摘

Cirrhosis and portal hypertension (PH) has a high incidence in China. Laparoscopic splenectomy and esophagogastric devascularization (LS + ED) was confirmed as an effective and safe surgical approach. But compared to open surgery (OS + ED), the rate of portal vein system thrombosis (PVST) was found to be higher after LS + ED. PVST is a common and potentially life-threatening complication after LS + ED in patients with cirrhosis and PH. Anti-coagulation therapy should be given early, but no standard plan for PSVT prophylaxis has been developed for all patients. In this study, the efficacy and safety of early use of low molecular weight heparin (LMWH) to prevent PVST were retrospectively evaluated compared with conventional anti-coagulant therapy. Of 219 patients with cirrhosis and PH undergoing LS + ED at our hospital from January 2008 to June 2013, 139 received early anti-coagulant therapy with LMWH, and 80 received conventional anti-coagulant therapy. The rates and types of PVST, perioperative coagulation function, intra-abdominal active bleeding, and esophagogastric variceal bleeding (EGVB) were compared in these two groups. Of the 139 patients in the early anti-coagulation group, 42 (30.2 %) experienced postoperative PVST, including two (1.4 %) with main trunk. Of the 80 patients in the conventional anti-coagulation group, 40 (50.0 %) experienced postoperative PVST, including 12 (15.0 %) with main trunk; three (3.8 %) experienced recurrent EGVB due to main trunk thrombosis, and one (1.3 %) underwent an immediate second laparotomy for uncontrollable active bleeding. The rates of postoperative PVST (P = 0.004), main trunk thrombosis (P = 0.000), and EGVB (P = 0.048) were significantly lower in the early than in the conventional anti-coagulant group, but all tested perioperative indices of coagulation function and rates of intraperitoneal active bleeding were similar. Early anti-coagulation with LMWH is safe and effective in patients with LS + ED for cirrhosis and PH. Keywords Portal hypertension Splenectomy and esophagogastric devascularization Laparoscopy Portal vein system thrombosis Anti-coagulant