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Abstract：
BACKGROUND: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis, yet there are fewer studies about predictors of PVT recanalization. We aimed to further explore the predictors of recanalization in cirrhotic PVT to facilitate accurate prediction of patients\' clinical status and timely initiation of appropriate treatment and interventions. To further investigate the benefits and risks of anticoagulant therapy in cirrhotic PVT patients.
METHODS: A retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality.
RESULTS: This study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P < 0.001) and a lower rate of PVT progression (6.9% vs. 54.7%, log-rank P = 0.002). There was no significant difference between different anticoagulation regimens for PVT recanalization. Anticoagulation therapy did not increase the incidence of bleeding complications(P = 0.407). At the end of the study follow-up, Child-Pugh classification, MELD score, and albumin level were better in the anticoagulation group than in the non-anticoagulation group. There was no significant difference in 2-year survival between the two groups.
CONCLUSIONS: Anticoagulation, massive ascites, history of splenectomy, Child-Pugh B/C class, and main portal vein width were associated with portal vein thrombosis recanalization. Anticoagulation may increase the rate of PVT recanalization and decrease the rate of PVT progression without increasing the rate of bleeding. Anticoagulation may be beneficial in improving liver function in patients with PVT in cirrhosis.
METHODS: A retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality.
RESULTS: This study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P < 0.001) and a lower rate of PVT progression (6.9% vs. 54.7%, log-rank P = 0.002). There was no significant difference between different anticoagulation regimens for PVT recanalization. Anticoagulation therapy did not increase the incidence of bleeding complications(P = 0.407). At the end of the study follow-up, Child-Pugh classification, MELD score, and albumin level were better in the anticoagulation group than in the non-anticoagulation group. There was no significant difference in 2-year survival between the two groups.
CONCLUSIONS: Anticoagulation, massive ascites, history of splenectomy, Child-Pugh B/C class, and main portal vein width were associated with portal vein thrombosis recanalization. Anticoagulation may increase the rate of PVT recanalization and decrease the rate of PVT progression without increasing the rate of bleeding. Anticoagulation may be beneficial in improving liver function in patients with PVT in cirrhosis.
摘要：
背景：门静脉血栓形成（PVT）是肝硬化的常见并发症，然而，关于PVT再通预测因子的研究较少。我们旨在进一步探讨肝硬化PVT再通的预测因素，以促进患者临床状态的准确预测，并及时启动适当的治疗和干预措施。进一步探讨肝硬化PVT患者抗凝治疗的益处和风险。
方法：对我院2016年1月至2022年12月的肝硬化PVT患者进行回顾性队列研究，主要终点是通过COX回归分析PVT再通的预测因子。其他包括出血率，肝功能,和死亡率。
结果：本研究共纳入82名患者，再通组30例，非再通组52例。抗凝治疗是门静脉血栓再通的唯一独立保护因素，独立危险因素包括大量腹水。脾切除术史,Child-PughB/C类,和门静脉的主干宽度。抗凝治疗与PVT再通率显著升高相关(75.9%vs.20%,对数秩P<0.001)和较低的PVT进展率(6.9%vs.54.7%,对数秩P=0.002)。不同抗凝方案对PVT再通的影响无显著性差异。抗凝治疗并未增加出血并发症的发生率(P=0.407)。在研究结束时，Child-Pugh分类,MELD得分,抗凝组的白蛋白水平优于非抗凝组。两组患者2年生存率差异无统计学意义。
结论：抗凝，大量的腹水，脾切除术史,Child-PughB/C类,门静脉主干宽度与门静脉血栓再通有关。抗凝治疗可提高PVT再通率，降低PVT进展率，而不增加出血率。抗凝可能有益于改善肝硬化PVT患者的肝功能。
方法：对我院2016年1月至2022年12月的肝硬化PVT患者进行回顾性队列研究，主要终点是通过COX回归分析PVT再通的预测因子。其他包括出血率，肝功能,和死亡率。
结果：本研究共纳入82名患者，再通组30例，非再通组52例。抗凝治疗是门静脉血栓再通的唯一独立保护因素，独立危险因素包括大量腹水。脾切除术史,Child-PughB/C类,和门静脉的主干宽度。抗凝治疗与PVT再通率显著升高相关(75.9%vs.20%,对数秩P<0.001)和较低的PVT进展率(6.9%vs.54.7%,对数秩P=0.002)。不同抗凝方案对PVT再通的影响无显著性差异。抗凝治疗并未增加出血并发症的发生率(P=0.407)。在研究结束时，Child-Pugh分类,MELD得分,抗凝组的白蛋白水平优于非抗凝组。两组患者2年生存率差异无统计学意义。
结论：抗凝，大量的腹水，脾切除术史,Child-PughB/C类,门静脉主干宽度与门静脉血栓再通有关。抗凝治疗可提高PVT再通率，降低PVT进展率，而不增加出血率。抗凝可能有益于改善肝硬化PVT患者的肝功能。
