AJG: 抗凝药物与经颈静脉肝内门静脉分流术治疗肝硬化门静脉血栓的疗效差异分析

2021-03-21 MedSci原创 MedSci原创

门静脉血栓形成(PVT)在肝硬化过程中并不罕见,它发生的风险会随着肝病严重程度的增加而增加。 阻塞性和广泛的PVT无疑与肝病相关的死亡率明显相关。

      门静脉血栓形成(PVT)在肝硬化过程中并不罕见,它发生的风险会随着肝病严重程度的增加而增加。 阻塞性和广泛的PVT无疑与肝病相关的死亡率明显相关。PVT治疗肝硬化的主要方法是在没有禁忌症的情况下进行抗凝(AC)药物治疗。但是,对于慢性病患者,AC的疗效并不理想。相比之下,患有严重门脉高压的患者可能会因行颈内肝门系统分流术(TIPS)而受益,因此,这项研究旨在前瞻性评估使用等待观策略(即不治疗),抗凝药物治疗和经颈静脉肝内门体分流术(TIPS)治疗肝硬化PVT的优劣。

 

 

 

      研究人员在2014年2月至2018年6月之间,前瞻性地纳入了396例非恶性PVT肝硬化患者,其中48例(12.1%)未接受治疗,63例(15.9%)接受了抗凝治疗,88例(22.2%)进行了TIPS,197例患者(49.8%)接受了TIPS加TIPS后抗凝治疗。治疗方案的选择主要取决于肝脏疾病的阶段(是否有症状性门静脉高压症)以及血栓的程度和范围。

 

 

 

     

      结果发现在平均31.7个月的随访期间,有312例患者(81.3%)实现了部分(n = 25)或完全(n = 287)的血管再通,其中9例(3.1%)发生了血栓再形成,64例(16.2%)出现了严重再通出血(7例与抗凝相关的出血[1.8%]),88例(22.2%)发展为明显的肝性脑病,100例患者(25.3%)死亡。在多元竞争风险回归模型中,TIPS和抗凝治疗与再通的可能性更高。使用依诺肝素或利伐沙班而不是华法林进行长期抗凝治疗与降低血栓形成风险和改善生存率有关,而不会增加出血风险。

 

 

 

 

      本项研究证实对于患有PVT肝硬化的患者,采用TIPS和抗凝药物结合方法可有效实现血管再通,并且门脉高压并发症和不良事件发生率低。

 

 

 

原始出处:

Lv, Yong. Et al. Anticoagulation and Transjugular Intrahepatic Portosystemic Shunt for the Management of Portal Vein Thrombosis in Cirrhosis.The American Journal of Gastroenterology.2021.

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createdName=minzju5052, createdTime=Wed Apr 21 21:19:33 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698202, encodeId=eb511698202d7, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Feb 08 13:19:33 CST 2022, time=2022-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965832, encodeId=0e3f96583253, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:07:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965830, encodeId=ed3296583009, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:44 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965829, encodeId=e9ef965829d8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:41 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965828, encodeId=07fd965828c8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965827, encodeId=741c96582e71, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:36 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965826, encodeId=dad09658268b, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:34 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955584, encodeId=6831955584c4, content=感谢好文!, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Fri Apr 09 22:30:54 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-05-15 ms5000000892437705

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1955531, encodeId=bdce195553126, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon May 10 05:19:33 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057327, encodeId=4849205e32756, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Wed Apr 21 21:19:33 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698202, encodeId=eb511698202d7, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Feb 08 13:19:33 CST 2022, time=2022-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965832, encodeId=0e3f96583253, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:41 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965828, encodeId=07fd965828c8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965827, encodeId=741c96582e71, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:36 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965826, encodeId=dad09658268b, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:34 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955584, encodeId=6831955584c4, content=感谢好文!, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Fri Apr 09 22:30:54 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-05-15 ms5000000892437705

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1955531, encodeId=bdce195553126, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon May 10 05:19:33 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057327, encodeId=4849205e32756, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, createdName=minzju5052, createdTime=Wed Apr 21 21:19:33 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698202, encodeId=eb511698202d7, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue Feb 08 13:19:33 CST 2022, time=2022-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965832, encodeId=0e3f96583253, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:41 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965828, encodeId=07fd965828c8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965827, encodeId=741c96582e71, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:36 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965826, encodeId=dad09658268b, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:34 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955584, encodeId=6831955584c4, content=感谢好文!, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Fri Apr 09 22:30:54 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-05-15 ms5000000892437705

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1955531, encodeId=bdce195553126, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon May 10 05:19:33 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057327, encodeId=4849205e32756, content=<a href='/topic/show?id=18982222db' target=_blank style='color:#2F92EE;'>#AJG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2222, encryptionId=18982222db, topicName=AJG)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2978132, 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createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:07:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965830, encodeId=ed3296583009, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:44 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965829, encodeId=e9ef965829d8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:41 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965828, encodeId=07fd965828c8, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:39 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965827, encodeId=741c96582e71, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:36 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965826, encodeId=dad09658268b, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Sat May 15 14:05:34 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955584, encodeId=6831955584c4, content=感谢好文!, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Fri Apr 09 22:30:54 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-05-15 ms5000000892437705

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  8. 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channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210528/a18cf35bdfab43d496bab2a120649fae/3b4d7ff9e9364c3bae15229ee94a1b36.jpg, createdBy=9ea25397643, createdName=ms5000000892437705, createdTime=Fri Apr 09 22:30:54 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-05-15 ms5000000892437705

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  9. 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    2021-05-15 ms5000000892437705

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    2021-04-09 ms5000000892437705

    感谢好文!

    0

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