title: Predictors of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection: A Retrospective Cohort Study of 75 Consecutive Patients with 3-months follow-up.
abstract: BACKGROUND
  Portal vein system thrombosis (PVST) is an alarming and potentially life-threatening complication of laparoscopic splenectomy and azygoportal disconnection (LSD). The objective of this study was to investigate negative and positive predictors of PVST after LSD in patients receiving anticoagulant regimens with aspirin or warfarin.
  
  
  METHODS
  Seventy-five consecutive patients who underwent LSD from 2013 to 2014 were retrospectively reviewed. Patients received anticoagulant regimen with warfarin (n = 35) or aspirin (n = 40) according to individual preference. International normalized ratio (INR) and the incidence of PSVT were compared in patients received anticoagulant regimen with warfarin or aspirin on postoperative days (POD) 7, 30, and 90, and factors associated with PVST at these time points were determined by univariate and logistic multivariable regression analyses.
  
  
  RESULTS
  Portal vein diameter was an independent negative predictor of PVST on PODs 7, 30, and 90. Anticoagulation with warfarin was an independent positive predictor of PVST on PODs 30 and 90, and INR was an independent positive predictor of PVST on POD 90. Dynamic changes in the incidence of PVST on the day of admission and on PODs 7, 30, and 90 differed significantly between the warfarin and aspirin groups (P = 0.002). No patient experienced perioperative bleeding.
  
  
  CONCLUSIONS
  Portal vein diameter was an independent negative predictor, while anticoagulation therapy with warfarin and INR were independent positive predictors, of PVST after LSD. Early anticoagulation with warfarin is safe and effective for the prevention of PVST after LSD.
authors.affiliation: Departments of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Jiang
authors.affiliation: Departments of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China. Electronic address: bdsno1@hotmail.com.
authors.forename: Dou-Sheng
authors.initials: DS
authors.lastname: Bai
authors.affiliation: Departments of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: Departments of Ultrasound, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
authors.forename: Bing-Lan
authors.initials: BL
authors.lastname: Xia
authors.affiliation: Departments of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Qian
authors.affiliation: Departments of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Jin
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001401:Azygos Vein / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Azygoportal disconnection; Laparoscopy; Portal vein thrombosis; Splenectomy; Warfarin