Impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis after splenectomy and devascularization
10.3760/cma.j.cn113884-20201228-00639
- VernacularTitle:脾切断流术后不同血小板水平开始抗凝对门静脉系统血栓形成的影响
- Author:
Baoliang LI
1
;
Ronghai HUANG
;
Li JIANG
Author Information
1. 首都医科大学附属北京地坛医院普通外科 100015
- Keywords:
Platelet count;
Splenectomy and pericardial devascularization;
Anticoagulation therapy;
Portal vein thrombosis
- From:
Chinese Journal of Hepatobiliary Surgery
2021;27(7):529-532
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis (PVT) after splenectomy and devascularization.Methods:From January 2014 to January 2017, 125 patients with liver cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization in Beijing Ditan Hospital, Capital Medical University. All patients routinely received anticoagulant therapy. There were 85 patients who had a platelet count greater than >100×10 9/L (the study group) and 40 patients who had a platelet count greater than >300×10 9/L (the control group). The incidence of PVT was compared between the two groups. Results:A total of 125 patients were included in the study, including 91 males and 34 females, aged 20-59 years. Age, gender, preoperative platelet level, preoperative splenic vein and portal vein width, preoperative coagulation function, preoperative liver function (Child classification), preoperative esophageal and gastric varices, operation time, preoperative bleeding time, preoperative venous blood flow velocity, coagulation function 1 week and 2 weeks after operation between the two groups were not significantly different (all P>0.05). Of 125 patients undergoing splenectomy and pericardial devascularization, PVT was not found in all patients before operation. The incidence of PVT was 39.2% (49/125) within one month after operation. Among the 85 patients in the study group, 28 patients developed PVT, and the incidence of thrombosis was 32.9% (28/85). In the control group, 21 patients developed PVT, and the thrombosis rate was 52.5% (21/40). The difference was significant (χ 2=4.366, P=0.037). After anticoagulant therapy, the incidence of bleeding in the study group was 4.7% (4/85), and that in the control group was 5.0% (2/40), the difference was no significant ( P>0.05). Conclusion:Early anticoagulation (platelet >100×10 9/L) does not increase the risk of postoperative bleeding, but can reduce the incidence of PVT.
