Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 14, 2012; 18(26): 3443-3450
Published online Jul 14, 2012. doi: 10.3748/wjg.v18.i26.3443
Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization
Wei Lai, Shi-Chun Lu, Guan-Yin Li, Chuan-Yun Li, Ju-Shan Wu, Qing-Liang Guo, Meng-Long Wang, Ning Li
Wei Lai, Shi-Chun Lu, Guan-Yin Li, Chuan-Yun Li, Ju-Shan Wu, Qing-Liang Guo, Meng-Long Wang, Ning Li, Department of Hepatobiliary Surgery and You-An Liver Transplantation Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
Author contributions: Lai W, Lu SC and Li GY contributed to acquisition, analysis and interpretation of data, drafted the article and revised it critically for important intellectual content; Li CY, Wu JS, Guo QL, Wang ML and Li N contributed to acquisition of data and drafted the article; all authors have read and approved the final version to be published.
Supported by Grants from Beijing Municipal Health Bureau, No. 2011-2-18
Correspondence to: Shi-Chun Lu, Professor, Department of Hepatobiliary Surgery and You-An Liver Transplantation Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China. lsc620213@yahoo.com.cn
Telephone: +86-10-63296493 Fax: +86-10-63296493
Received: September 6, 2011
Revised: November 24, 2011
Accepted: March 10, 2012
Published online: July 14, 2012
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.

Keywords: Portal vein hypertension, Splenectomy with gastroesophageal devascularization, Portal or splenic vein thrombosis, Anticoagulation regimen, Thrombolytic therapy