背景:近年来,新的口服抗凝剂(NOAC)已变得普遍,并且越来越多地用于治疗端口静脉血栓形成。利伐沙班和达比加群治疗肝硬化合并急性门静脉血栓形成(PVT)的疗效和安全性差异尚不清楚。
方法:这项回顾性研究纳入了我们研究所2020年1月至2021年12月的所有连续肝硬化急性门静脉血栓形成患者。患者接受利伐沙班或达比加群口服抗凝治疗。人口统计,临床,收集患者影像学资料。影像学检查证实了急性PVT的诊断。使用Child-Pugh评分和终末期肝病模型(MELD)评分评估肝硬化的严重程度。结果包括再通(完整,局部,和持续遮挡),肝功能,出血,和生存。使用对数秩检验比较事件发生时间结果的Kaplan-Meier分布。使用Cox比例风险模型以95%置信区间(CI)计算风险比(HR)。
结果:共纳入94例患者,52例患者(55%)接受了利伐沙班,42例(45%)接受了达比加群。在41例患者中观察到PVT的完全和部分再通。完全再通没有显着差异,部分再通,两组之间的持续闭塞。通过多变量分析,D-二聚体(HR1.165,95%CI1.036-1.311,p=0.011)是完全再通的独立预测因子。两组抗凝后Child-Pugh评分(p=0.001)均有显著改善,分别。然而,两组间无差异。生存率为94%,利伐沙班和达比加群组有95%(对数秩p=0.830)。利伐沙班组有3例患者(6%)和达比加群组有1例患者(2%)出现严重出血(p=0.646)。利伐沙班组有6例患者(12%)出现轻微出血,达比加群组有5人(12%)(p=0.691)。
结论:利伐沙班和达比加群治疗肝硬化合并急性门静脉血栓形成的疗效和安全性相当。D-二聚体有助于预测肝硬化患者PVT再通。
BACKGROUND: New oral anticoagulants (NOACs) have been becoming prevalent in recent years and are increasingly used in the treatment of port vein thrombosis. The difference of the efficacy and safety between rivaroxaban and dabigatran remains unclear in the treatment of cirrhotic patients with acute portal vein thrombosis (PVT).
METHODS: This retrospective study included all consecutive cirrhotic patients with acute portal vein thrombosis in our institute from January 2020 to December 2021. The patients received oral anticoagulation with rivaroxaban or dabigatran. The demographic, clinical, and imaging data of patients were collected. The diagnosis of acute PVT was confirmed by imaging examinations. The severity of liver cirrhosis was assessed using Child-Pugh score and Model for End-Stage Liver Disease (MELD) score. Outcomes included recanalization (complete, partial, and persistent occlusion), liver function, bleedings, and survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS: A total of 94 patients were included, 52 patients (55%) received rivaroxaban and 42 (45%) with dabigatran. The complete and partial recanalization of PVT was observed in 41 patients. There was no significant difference in complete recanalization, partial recanalization, and persistent occlusion between the two groups. With multivariate analysis, D-dimer (HR 1.165, 95% CI 1.036-1.311, p = 0.011) was independent predictors of complete recanalization. The Child-Pugh score (p = 0.001) was significantly improved in both two groups after anticoagulation, respectively. However, there was no difference between the two groups. The probability of survival was 94%, 95% in the rivaroxaban and dabigatran groups (log-rank p = 0.830). Major bleedings were reported in 3 patients (6%) in rivaroxaban group and 1 patient (2%) in dabigatran group (p = 0.646). Six patients (12%) in rivaroxaban group experienced minor bleeding, and five (12%) from dabigatran group (p = 0.691).
CONCLUSIONS: The efficacy and safety were comparable between rivaroxaban and dabigatran in the treatment of cirrhotic patients with acute portal vein thrombosis. And D-dimer can contribute to the prediction of PVT recanalization in cirrhotic patients.