背景:先天性门体分流术(CPSS)是罕见的先天性异常,导致门静脉和体循环之间的异常血流。这项研究报告了CPSS患者封堵后的围手术期抗凝管理,重点关注血栓性和出血并发症的发生率。
方法:这是对2005年至2021年期间接受手术或血管内介入治疗的CPSS患者的单中心回顾性分析。该方案包括在手术期间和手术后立即使用普通肝素(UFH),术后使用华法林或低分子量肝素(LMWH)。评估的结果包括术后血栓形成和出血并发症。
结果:共纳入44例患者。术后,89%接受治疗剂量UFH,出院时过渡到华法林或LMWH。16%的患者发生血栓并发症,主要在肠系膜上静脉。手术干预和组织纤溶酶原激活剂(tPA)的连续输注用于凝块分辨率。64%的患者出现出血并发症,主要通过输血和临时UFH中断进行管理。没有与血栓有关的死亡,或报告出血事件.
结论:我们的发现强调了CPSS患者抗凝管理所需的微妙平衡,显示术后血栓和出血并发症的发生。
方法:二级,回顾性研究。
BACKGROUND: Congenital portosystemic shunts (CPSS) are rare congenital abnormalities causing abnormal blood flow between the portal vein and systemic circulation. This study reports on the peri-operative anticoagulation management of CPSS patients post closure, focusing on the incidence of thrombotic and bleeding complications.
METHODS: This is a single-center retrospective analysis of CPSS patients who underwent surgery or endovascular intervention between 2005 and 2021. The protocol included unfractionated heparin (UFH) during and immediately after surgery, followed by either warfarin or low molecular weight heparin (LMWH) postoperatively. Outcomes assessed included postoperative thrombotic and bleeding complications.
RESULTS: A total of 44 patients were included. Postoperatively, 89% received treatment-dose UFH, transitioning to warfarin or LMWH at discharge. Thrombotic complications occurred in 16% of patients, predominantly in the superior mesenteric vein. Surgical interventions and continuous infusion of tissue plasminogen activator (tPA) were used for clot resolution. Bleeding complications were observed in 64% of patients, primarily managed with transfusions and temporary UFH interruption. No deaths related to thrombotic, or bleeding events were reported.
CONCLUSIONS: Our findings underscore the delicate balance required in anticoagulation management for CPSS patients, revealing an occurrence of both thrombotic and bleeding complications postoperatively.
METHODS: Level II, retrospective study.