The Treatment Of Preoperative Anticoagulation And Earleer Postroerative Anticoagulation For Portal Hupertension Patients

ObjectiveTo investigate the practicability of surgical operation to portal hypertension patients complicated with portal vein thrombosis and the effect of earlier anticoagulation in prevention of portal system thrombosis in patients of portal hypertension postoperatively. after extensive esophagogastric devascularization.Methods1,Patients and controls:We selected 10 portal hypertension patients complicated with portal vein thrombosis who underwent he treatment of preoperative thrombolysis and postoperative earlier anticoagulation postoperatively, male 7, female 3,36-58 years, median age 45, Their clinical information and survival situation were retrospectively analyzed with 113 portal hypertension patients reviewed from 2003.01 to 2008.12.2. Treatment:firstly, we used Low Molecular Weight Heparin (LMWH) 7 days for anticoagulation; the dose of LMWH is 5000AXaIU, subcutaneous. Take warfarin at the forth days after LMWH was given. The original dose is 3mg.Adjust dose of the warfarin according to prothrombin time (PT), prothrombin activity (PA), International normalized ratio. All these 10 patients were given hepatic protect ant and accept extensive esophagogastric devascularization. And on the third day after the operation, we begin to antiplatelet treatment oral intaking aspirin by 100mg/d.3. By retrospectively contrasting the two groups of patients, AST.ALT,TBIL,PLT count postoperatively, the rate of bleeding, portal system thrombosis both postoperatively and long term outpatient visits. to analyze the security and practicability of preoperative thrombolysis therapy, the effectiveness of earlier postoperative anticoagulant therapy.ResultsThe 10 portal hypertension patients complicated with portal vein thrombosis, after the treatment of preoperative thrombolysis, anticoagulation and hepatic protect ant, the thrombosis was reduced or absent, liver function was improved, there were none absolute operation contraindications, they all accepted the extensive esophagogastric devascularization.the 10 PVT patients who underwent splenectomy and devascularization with earlier postoperative anticoagulation, none (0%) of them had bleeding, while the control group 191 patients underwent the same operation without earlier postoperative anticoagulation,2(1.8%) of them had bleeding. The data of these two groups have no significant difference (P>0.05). The two group's factors of liver function also have no significant difference (P>0.05).After the earlier postoperative anticoagulation treatment, one patient was found PVT arises, which was extra hepatic portal vein thrombosis found by CT, the rate of PVT is 10%,while the rate of control group is 21.2%(24/113), The data of these two groups have significant difference (P<0.05). the patient who occurred PVT was given anticoagulation treatment adding low-molecular-weight Heparins, 1000U/d, at the speed of 500U/h for 7 days, the portal vein thrombosis disappeared. In long-term follow-up studies, the PVT rate of earlier postoperative anticoagulation group is 30%(3/10), and the control group 52.2%(59/113),which also have significant difference (P<0.05).ConclusionsBy the treatment of preoperative thrombolysis, the portal vein thrombosis of the patients who are portal hypertension complicated PVT would disappear or reduce, and the liver function would be finer; they can tolerate the extensive esophagogastric devascularization. This treatment is a good choose for the PHT patients who complicated PVT. The treatment of earlier postoperative anticoagulation for portal hypertension patients, is an effective methods in preventing and managing portal thrombosis post-operation for portal hypertension. the number of bleeding episodes in PVT patients receiving anticoagulant therapy did not increased, and in long-term follow-up studies, anticoagulants seem to be effective in preventing new thrombotic events with a low mortality.In the long-term follow-up studies, the application of anticoagulant therapy in PVT patients with cirrhosis obtains an improvement in survival and reduction in risk of gastrointestinal bleeding; it's still an effective treatment.