title: Follow-up results of acute portal and splenic vein thrombosis with or without anticoagulation therapy after hepatobiliary and pancreatic surgery.
abstract: OBJECTIVE
  Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery.
  
  
  METHODS
  We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups.
  
  
  RESULTS
  APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296).
  
  
  CONCLUSIONS
  Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chan Woo
authors.initials: CW
authors.lastname: Cho
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yang Jin
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young-Wook
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong-Ik
authors.initials: DI
authors.lastname: Kim
keywords: Anticoagulants; Mesentery; Portal vein; Surgery; Thrombosis
references.citation: J Blood Med. 2013 Aug 01;4:89-99
references.pmid: 24019755
references.citation: Hepatology. 2000 Sep;32(3):466-70
references.pmid: 10960436
references.citation: Surgery. 1994 Mar;115(3):389-93
references.pmid: 8128363
references.citation: J Gastrointest Surg. 2004 Dec;8(8):935-49; discussion 949-50
references.pmid: 15585381
references.citation: Hepatogastroenterology. 2003 Nov-Dec;50(54):2098-100
references.pmid: 14696472
references.citation: N Engl J Med. 2001 Dec 6;345(23):1683-8
references.pmid: 11759648
references.citation: Am J Gastroenterol. 2002 Mar;97(3):535-41
references.pmid: 11922544
references.citation: Semin Liver Dis. 2008 Aug;28(3):282-92
references.pmid: 18814081
references.citation: Surgery. 2008 Apr;143(4):566-7
references.pmid: 18374055
references.citation: Gastroenterol Res Pract. 2008;2008:896320
references.pmid: 19043605
references.citation: J Gastrointest Surg. 2006 Dec;10(10):1371-5
references.pmid: 17175456
references.citation: Arch Intern Med. 2005 May 23;165(10):1095-106
references.pmid: 15911722
references.citation: Europace. 2011 May;13(5):723-46
references.pmid: 21515596
references.citation: Thromb Haemost. 2009 Aug;102(2):268-78
references.pmid: 19652877
references.citation: Am Surg. 2004 Jul;70(7):600-4
references.pmid: 15279182
references.citation: World J Surg. 2006 Aug;30(8):1526-35
references.pmid: 16855797
references.citation: Gastroenterology. 2001 Feb;120(2):490-7
references.pmid: 11159889
references.citation: HPB (Oxford). 2011 Jul;13(7):494-502
references.pmid: 21689233
references.citation: J Gastrointest Surg. 2010 Mar;14(3):570-7
references.pmid: 19582513
references.citation: Transplantation. 2000 May 15;69(9):1873-81
references.pmid: 10830225
references.citation: Hepatology. 2010 Jan;51(1):210-8
references.pmid: 19821530
references.citation: Gut. 2001 Nov;49(5):720-4
references.pmid: 11600478
references.citation: J Vasc Surg. 2003 Dec;38(6):1411-5
references.pmid: 14681650
references.citation: Am Heart J. 2005 Apr;149(4):650-6
references.pmid: 15990748
references.citation: AJR Am J Roentgenol. 1997 Mar;168(3):719-23
references.pmid: 9057522
references.citation: Br J Surg. 1997 Jan;84(1):129-32
references.pmid: 9043477
references.citation: Diagn Interv Radiol. 2006 Jun;12 (2):105-7
references.pmid: 16752359