Analysis of the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt
10.3760/cma.j.cn501113-20210106-00010
- VernacularTitle:经颈静脉肝内门体静脉分流术后支架堵塞的影响因素及抗凝治疗必要性分析
- Author:
Yifu XIA
1
;
Lijun SONG
;
Guangchuan WANG
;
Guangjun HUANG
;
Chunqing ZHANG
Author Information
1. 山东大学山东省立医院消化内科，济南 250021
- Keywords:
Hepatic encephalopathy;
Transjugular intrahepatic portosystemic shunt;
Anticoagulation therapy;
Stent blockage;
Stent stenosis;
Platelet;
Rebleeding;
Ascites
- From:
Chinese Journal of Hepatology
2022;30(7):728-734
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt.Methods:The basic information, laboratory test results, preoperative portal venous pressure, postoperative anticoagulation time, postoperative stent stenosis or occlusion, followed-up and other data of all patients who underwent TIPS surgery in Shandong Provincial Hospital from 2010 to 2019 were retrospectively analyzed. Data were analyzed using t-test, χ2 test, and multivariate analysis (logistic regression and Cox-regression-analysis). Results:A total of 280 cases were finally included in the study, of which 110 (39.3%) had stent stenosis or occlusion, and 170 (60.7%) had stent patency. New or worsening ascites were identified in 194 cases during the follow-up period, including 14 (31.1%) cases in the stent stenosis or occlusion group and 19 (12.8%) cases in the stent patency group. Univariate analysis showed that presence or absence of platelet ( P=0.037) and total bilirubin ( P=0.038) were correlated with stent stenosis or occlusion. Postoperative continuous anticoagulation was correlated with stent blockage ( P=0.029) in patients with partial portal vein thrombosis. Postoperative continuous anticoagulation and stent occlusions were not significantly correlated in patients with preoperative portal cavernoma and preoperative portal vein patency ( P=0.848; P=0.744). Multivariate analysis results showed that whether long-term anticoagulation ( P=0.017), all-cause rebleeding ( P<0.001), postoperative significant hepatic encephalopathy ( P<0.012), and postoperative new or worsening ascites ( P<0.001) was significantly associated with stent occlusion ( P<0.05), while platelets ( P=0.134), total bilirubin ( P=0.229), international normalized ratio ( P=0.436), and portal vein pressure ( P=0.230) were not significantly associated with stent occlusion after surgery. Conclusion:In patients with partial portal vein thrombosis before surgery, continuous anticoagulation for 30 days post-TIPS therapy can effectively prevent stent stenosis or occlusion; while in patients with portal vein patency, portal cavernoma and complete portal vein blockage before surgery, postoperative anticoagulation has no significant effect on stent stenosis or occlusion.
