Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Hepatobiliary Surgery and You-An Liver Transplantation Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China.
Wei
W
Lai
Shi-Chun
SC
Lu
Guan-Yin
GY
Li
Chuan-Yun
CY
Li
Ju-Shan
JS
Wu
Qing-Liang
QL
Guo
Meng-Long
ML
Wang
Ning
N
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011169:Portal Vein / Q000473:pathology; D011517:Prothrombin Time; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013162:Splenic Vein / Q000473:pathology; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000175:diagnosis* / Q000503:physiopathology; D018608:Ultrasonography, Doppler / Q000379:methods; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants