title: Anticoagulation Therapy with Warfarin Versus Low-Dose Aspirin Prevents Portal Vein Thrombosis After Laparoscopic Splenectomy and Azygoportal Disconnection.
abstract: BACKGROUND
  Portal vein system thrombosis (PVST) is a frequent and potentially life-threatening complication after laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhotic portal hypertension. The objective of this study was to investigate the safety and effectiveness of warfarin with a target international normalized ratio (INR) of 2.0-2.5 for the prevention of PVST after LSD. Hitherto, this is the first study to assess the use of warfarin in this field.
  
  
  METHODS
  We retrospectively analyzed a database of 73 consecutive patients who underwent LSD from January 2013 to September 2014. Patients were categorized into the warfarin group (34 patients) and the aspirin group (39 patients). The INR and incidence of PSVT were monitored for 90 days.
  
  
  RESULTS
  Compared with the aspirin group, the warfarin group had a lower incidence of PVST on postoperative day (POD) 30 [17/34 (50.0%) versus 29/39 (74.4%); P = .032] and POD 90 [8/34 (23.5%) versus 30/39 (76.9%); P < .0001] and main portal vein thrombosis (MPVT) on POD 90 [3 (8.8%) versus 13 (33.3%); P = .012]. From POD 30 to 90, the warfarin group achieved more complete recanalization of PVST [9/17 (52.9%) versus 3/29 (10.3%), P = .005] and MPVT [9/12 (75.0%) versus 3/12 (25.0%), P = .039]. Multiple logistic regression analysis revealed that warfarin was an independent protective factor for PVST at POD 90 (relative risk, 0.027; 95% confidence interval, 0.004-0.168; P < .001). No patients developed bleeding complications.
  
  
  CONCLUSIONS
  Anticoagulation therapy with warfarin is safe and effective for the prevention of PVST in cirrhotic patients with portal hypertension after LSD.
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Jiang
authors.affiliation: 2 Department of Ultrasound, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Bing-Lan
authors.initials: BL
authors.lastname: Xia
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Qian
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Jin
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Si-Qin
authors.initials: SQ
authors.lastname: Zuo
authors.affiliation: 1 Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China .
authors.forename: Dou-Sheng
authors.initials: DS
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001401:Azygos Vein / Q000601:surgery; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D001241:Aspirin