Analysis on incidence and risk factors of hemorrhagic events during anticoagulation therapy with warfarin in patients with liver cirrhosis and portal vein thrombosis after trans-jugular intrahepatic portosystemic shunt
10.3760/cma.j.issn.1008-5734.2018.04.004
- VernacularTitle:肝硬化门静脉血栓患者经颈静脉肝内门体分流术后华法林抗凝治疗中出血事件发生情况及危险因素分析
- Author:
Zhengyu WANG
1
;
Bohan LUO
1
;
Yong LYU
1
;
Jing NIU
1
;
Jie YUAN
1
;
Na HAN
1
;
Xiaomei LI
1
;
Ying ZHU
1
;
Hui CHEN
1
;
Chuangye HE
1
;
Zhanxin YIN
1
;
Hange SONG
1
;
Guohong HAN
1
Author Information
1. 710032西安,空军军医大学西京消化病医院消化介入科,国家消化系统疾病临床医学研究中心
- Publication Type:Journal Article
- Keywords:
Cirrhosis;
Portasystemic shunt,transjugular intrahepatic;
Warfarin;
Hemorrhage
- From:
Adverse Drug Reactions Journal
2018;20(4):259-265
- CountryChina
- Language:Chinese
-
Abstract:
Objective To understand the incidence and risk factors of warfarin related hemorrhagic events during anticoagulation therapy with warfarin in patients with cirrhosis and portal vein thrombosis (PVT)after transjugular intrahepatic portosystemic shunt (TIPS). Methods The patients with liver cirrhosis who were treated with warfarin after TIPS due to portal hypertension were followed up from January 2012 in Xijing Hospital of Digestive Diseases,Air Force Military Medical University. The data of medical records and follow-up records up to the end of December 2015 in patients undergoing TIPS were collected and retrospectively analyzed. Cumulative incidence of hemorrhagic events related to warfarin treatment was calculated by Kaplan-Meier method. The patients were divided into warfarin-related bleeding group (bleeding group ) and non warfarin-related bleeding group (non-bleeding group ). The risk factors of hemorrhagic events related to warfarin treatment were analyzed using Cox regression model and the hazard ratio (HR)and the 95% confidence interval (CI)were calculated. Results A total of 179 patients were enrolled,including 117 males and 62 females with ages of 25-79 years and average age of (52 ± 12)years;the bleeding group comprised 47 patients (26.3%)and the non-bleeding group comprised 132 patients (73.7%). The follow-up time after discharge ranged 1-74 months and the average time was (28 ± 21) months. The average portal pressure gradient dropped from (25.4 ± 5.2)to (8.7 ± 3.7)mmHg before and after TIPS (P＜0.001). The median dose of oral warfarin in patients in the bleeding group was 2.5 (ranged from 2.5 to 3.75)mg and the median INR was 3.12 (ranged from 2.04 to 9.41);the median dose of oral warfarin in patients in the non-bleeding group was 1.8 (ranged from 0.63 to 2.5)mg and the median INR was 1.85 (ranged from 1.5 to 3.38). Fifty eight cases of hemorrhagic events occurred in 47 patients in the bleeding group,including 24 cases of gingival bleeding,16 cases of epistaxis,8 cases of cutaneous purpura, 4 cases of conjunctival hemorrhage,2 cases of hemorrhage of digestive tract,2 cases of intracranial hemorrhage,1 cases of hematuria,and 1 cases of menorrhagia. Nine of the 47 patients in the bleeding group had bleeding from multiple sites. The results of Kaplan-Meier analysis showed that the 1-,2-,3-,4-,5-and 6-year cumulative incidences of hemorrhagic events related to warfarin treatment after operation were 19%,23%,24%,30%,41%,and 45%,respectively. Warfarin was stopped in 11 patients and given at reduced doses in 36 patients among the 47 patients in the bleeding group. After that,43 patients'hemorrhagic symptoms disappeared and 3 patients' symptoms relieved,and then warfarin treatments were continued,except that 1 patient with a long history of hypertension died of intracranial hemorrhage. Multiple Cox regression analysis showed that the baseline serum creatinine level ＞115 μmol/L was an independent risk factor for hemorrhagic events related to warfarin treatment (HR＝1.82,95%CI:1.01-3.28,P＝0.045). Conclusions It is relatively safe for patients with liver cirrhosis and PVT receiving warfarin anticoagulation therapy after TIPS. Elevated serum creatinine is an independent risk factor for hemorrhagic events related to warfarin treatment.
