Anticoagulation Therapy with Warfarin Versus Low-Dose Aspirin Prevents Portal Vein Thrombosis After Laparoscopic Splenectomy and Azygoportal Disconnection.

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  • Additional Information
    • Source:
      Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 9706293 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-9034 (Electronic) Linking ISSN: 10926429 NLM ISO Abbreviation: J Laparoendosc Adv Surg Tech A Subsets: MEDLINE
    • Publication Information:
      Original Publication: Larchmont, NY : Mary Ann Liebert, Inc., c1997-
    • Subject Terms:
      Portal Vein*; Postoperative Complications/*prevention & control ; Splenectomy/*adverse effects ; Venous Thrombosis/*prevention & control; Adolescent ; Adult ; Aged ; Anticoagulants/administration & dosage ; Anticoagulants/therapeutic use ; Aspirin/administration & dosage ; Aspirin/therapeutic use ; Azygos Vein/surgery ; Female ; Heparin, Low-Molecular-Weight/administration & dosage ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Liver Cirrhosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Warfarin/administration & dosage ; Warfarin/therapeutic use ; Young Adult
    • Abstract:
      Background: Portal vein system thrombosis (PVST) is a frequent and potentially life-threatening complication after laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhotic portal hypertension. The objective of this study was to investigate the safety and effectiveness of warfarin with a target international normalized ratio (INR) of 2.0-2.5 for the prevention of PVST after LSD. Hitherto, this is the first study to assess the use of warfarin in this field.
      Materials and Methods: We retrospectively analyzed a database of 73 consecutive patients who underwent LSD from January 2013 to September 2014. Patients were categorized into the warfarin group (34 patients) and the aspirin group (39 patients). The INR and incidence of PSVT were monitored for 90 days.
      Results: Compared with the aspirin group, the warfarin group had a lower incidence of PVST on postoperative day (POD) 30 [17/34 (50.0%) versus 29/39 (74.4%); P = .032] and POD 90 [8/34 (23.5%) versus 30/39 (76.9%); P < .0001] and main portal vein thrombosis (MPVT) on POD 90 [3 (8.8%) versus 13 (33.3%); P = .012]. From POD 30 to 90, the warfarin group achieved more complete recanalization of PVST [9/17 (52.9%) versus 3/29 (10.3%), P = .005] and MPVT [9/12 (75.0%) versus 3/12 (25.0%), P = .039]. Multiple logistic regression analysis revealed that warfarin was an independent protective factor for PVST at POD 90 (relative risk, 0.027; 95% confidence interval, 0.004-0.168; P < .001). No patients developed bleeding complications.
      Conclusions: Anticoagulation therapy with warfarin is safe and effective for the prevention of PVST in cirrhotic patients with portal hypertension after LSD.
    • Accession Number:
      0 (Anticoagulants)
      0 (Heparin, Low-Molecular-Weight)
      5Q7ZVV76EI (Warfarin)
      R16CO5Y76E (Aspirin)
    • Publication Date:
      Date Created: 20160412 Date Completed: 20170322 Latest Revision: 20181202
    • Publication Date:
      20240104
    • Accession Number:
      10.1089/lap.2016.0012
    • Accession Number:
      27064832