Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

Abstract

Aim: To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.

Methods: We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.

Results: The patients' data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.

Conclusion: Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Keywords: Anticoagulation regimen; Portal or splenic vein thrombosis; Portal vein hypertension; Splenectomy with gastroesophageal devascularization; Thrombolytic therapy.

Figure 1

Changes in platelet count and prothrombin time/international normalized ratio in group A and group B. It was not different in platelet (PLT) between the two groups (P = 0.981), but it was statistically different in prothrombin time/international normalized ratio (PT/INR) between the two groups (P = 0.020). PT/INR in group A had no sequential changes pre- and post-operatively (P = 0.479) and PT/INR in group B was increasing gradually from postoperative day 7 with statistical difference (P = 0.003). POD: Postoperative day.

Figure 2

Changes in prothrombin time/international normalized ratio in patients without portal or splenic vein thrombosis and portal or splenic vein thrombosis. In group A, patients with or without portal or splenic vein thrombosis (PSVT) had similar prothrombin time/international normalized ratio (PT/INR), and the difference was not significant between the two subgroups. Patients with or without PSVT presented different PT/INR only at day 14 after surgery, with statistical significance (1.23 ± 0.17 vs 1.30 ± 0.21, P = 0.037) by Student’s t test. In group B, patients with or without PSVT had different PT/INR only at day 14 after surgery, with statistical significance (1.18 ± 0.14 vs 1.28 ± 0.21, P = 0.017) by Student’s t test. POD: Postoperative day.