A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization

Abstract

Cirrhosis and portal hypertension (PH) has a high incidence in China. Laparoscopic splenectomy and esophagogastric devascularization (LS + ED) was confirmed as an effective and safe surgical approach. But compared to open surgery (OS + ED), the rate of portal vein system thrombosis (PVST) was found to be higher after LS + ED. PVST is a common and potentially life-threatening complication after LS + ED in patients with cirrhosis and PH. Anti-coagulation therapy should be given early, but no standard plan for PSVT prophylaxis has been developed for all patients. In this study, the efficacy and safety of early use of low molecular weight heparin (LMWH) to prevent PVST were retrospectively evaluated compared with conventional anti-coagulant therapy. Of 219 patients with cirrhosis and PH undergoing LS + ED at our hospital from January 2008 to June 2013, 139 received early anti-coagulant therapy with LMWH, and 80 received conventional anti-coagulant therapy. The rates and types of PVST, perioperative coagulation function, intra-abdominal active bleeding, and esophagogastric variceal bleeding (EGVB) were compared in these two groups. Of the 139 patients in the early anti-coagulation group, 42 (30.2 %) experienced postoperative PVST, including two (1.4 %) with main trunk. Of the 80 patients in the conventional anti-coagulation group, 40 (50.0 %) experienced postoperative PVST, including 12 (15.0 %) with main trunk; three (3.8 %) experienced recurrent EGVB due to main trunk thrombosis, and one (1.3 %) underwent an immediate second laparotomy for uncontrollable active bleeding. The rates of postoperative PVST (P = 0.004), main trunk thrombosis (P = 0.000), and EGVB (P = 0.048) were significantly lower in the early than in the conventional anti-coagulant group, but all tested perioperative indices of coagulation function and rates of intraperitoneal active bleeding were similar. Early anti-coagulation with LMWH is safe and effective in patients with LS + ED for cirrhosis and PH.

Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension.

“…That is to say, postoperative platelet counts may not be a risk factor for postoperative PVT. Furthermore, the total PVT rate was 20.8% (15/72) without any anticoagulant therapy, which was lower than that previously reported [16, 17]. The postoperative esophagogastric varices rebleeding rate was low in the LSEGDS group (6.2%, 2/32) compared with the LEGDS group (10%, 4/40) but the difference was not significant.…”

Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization

“…The incidence of PVST, which is measured in patients with wider internal diameter of the splenic vein, as well as portal vein and increased portal vein flow, remains high, indicating that these indicators can be used as markers of PVST prediction in cirrhotic patients with PH and EGVB. Early heparin therapy should be recommended in patients who have these factors after the operation [ 50 ].…”

The Best Anticoagulation Strategy for Cirrhotic Patients who Underwent Splenectomy: A Network Meta-Analysis

“…Through the literature search and selection based on the criteria above, we identified 2027 relevant citations, and finally 11 studies (from 2000 to 2016) containing 1153 patients [22–32] were included in this meta-analysis (Figure 1). These 11 Asian studies (Table 1) reported 8 anticoagulation strategies including: Antithrombin III (ATIII), low-molecular-weight heparin (LMWH) plus Warfarin plus Aspirin, LMWH plus Warfarin, Urokinase + Aspirin, Warfarin, Alprostadil, Aspirin, LMWH plus Aspirin.…”