Impact of Antithrombin III Concentrates on Portal Vein Thrombosis After Splenectomy in Patients With Liver Cirrhosis and Hypersplenism
Impact of Antithrombin III Concentrates on Portal Vein Thrombosis After Splenectomy in Patients With Liver Cirrhosis and Hypersplenism
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DOI：
10.1097/sla.0b013e3181bdf8ad
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发表时间：
2010-01-01
影响因子：
9
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Kawanaka, Hirofumi;Akahoshi, Tomohiko;Maehara, Yoshihiko
目的：探讨抗凝血酶III(AT-III)在肝硬变患者脾切除术后门静脉血栓形成(PVT)中的作用。摘要背景资料：目前对肝硬变脾切除术后门静脉血栓形成尚无标准的治疗方法。2005年1月至2005年12月，25例肝硬变患者术后未接受预防性抗凝治疗(AT-III[-]组)。从2006年1月至2006年7月，25例肝硬变患者在术后第1、2、3天(POD)预防性应用AT-III浓缩液(1500 U/d)(AT-III[+]组)。结果：在AT-III(-)组中，9例(36.0%)患者在术后7天发生PVT，其危险因素为：低血小板计数、低AT-III活性和脾重量增加。尽管包括上述危险因素在内的临床特征在两组间无显著差异，但AT-III组仅有1例(4.0%)患者在术后30天发生PVT，其发生率显著低于AT-III组(P=0.01)。在AT-III(-)组，AT-III活性从POD I到POD 7与术前相比显著降低，而AT-III浓度阻止了术后AT-III活性的下降。结论：这些结果表明，AT-III活性降低和AT-III活性的进一步降低与肝硬变患者术后门静脉血栓形成有关，AT-III浓缩液治疗可能阻止这些患者的门静脉血栓形成。
Objective: The aim of this study was to determine the role of antithrombin III (AT-III) in portal vein thrombosis (PVT) after splenectomy in cirrhotic patients.Summary Background Data: There is no standard treatment for PVT after splenectomy in liver cirrhosis.Methods: A total of 50 consecutive cirrhotic patients who underwent laparoscopic splenectomy for hypersplenism were enrolled into this study. From January 2005 to December 2005, 25 cirrhotic patients received no prophylactic anticoagulation therapy after the operation (AT-III [-] group). From January 2006 to July 2006, 25 cirrhotic patients received prophylactic administration of AT-III concentrates (1500 U/d) on postoperative day (POD) 1, 2, and 3 (AT-III [+] group).Results: In AT-III (-) group, 9 (36.0%) patients developed PVT up to POD 7, and risk factors for PVT were identified as: low platelet counts, low AT-III activity, and increased spleen weight. Although there were no significant differences in the clinical characteristics, including the above risk factors, between the 2 groups, only 1 (4.0%) patient developed PVT on POD 30 in AT-III group, and the incidence of PVT was significantly lower than in AT-III group (P = 0.01). In AT-III (-) group, AT-III activity was significantly decreased from POD I to POD 7, as compared with the preoperative level, whereas AT-III concentrates prevented the postoperative decrease in AT-III activity.Conclusions: These results demonstrate that low AT-III activity and further decreases in this activity are associated with PVT after splenectomy in cirrhotic patients, and that treatment with AT-III concentrates is likely to prevent the development of PVT in these patients.