Effect of Low Molecular Weight Heparin Calcium on the Occurrence of Portal Vein Thrombosis (PVT) after Splenectomy in Patients with Portal Hypertension (PH)
JI Fu-long, KONG Yan-xia, SHI Pi-ye
The Affiliated Huxi Hospital of Jining Medical University (Shanxian Central Hospital), Heze 274300, Shandong, China
Abstract：【Objective】To investigate the effect of low molecular weight heparin calcium on the occurrence of portal vein thrombosis (PVT) after splenectomy in patients with portal hypertension (PH).【Methods】Sixty-six patients with PH underwent splenectomy from January2015 to December 2016 in our hospital were enrolled for the study and randomly divided into group A and group B, 33 cases in each group. Patients in the group A were treated with low-molecular-weight heparin and low molecular dextran combined anticoagulant therapy at the early postoperative stage. The group B received low-molecular-weight dextran after operation. When the platelet count (PLT) counts were more than 100×109/L, low molecular weight heparin calcium was used. The incidence of PVT, hemostasis and coagulation function were compared between the two groups. The bleeding was recorded in both groups.【Results】There were 20 cases of PVT in 66 patients within 2 weeks after operation, the total incidence was 30.3%.The incidence of PVT in the group A 18.2% (6 / 66) was significantly lower than that in the group B 42.4% (14 / 66), the difference was statistically significant (P<0.05). The PLT count of the two groups on d3、d7、d14was significantly higher than that on the d1, the difference is statistically significant (P<0.05). The prothrombin time (PTT), activated partial thromboplastin time (APTT) and thrombin time (TTT) were in a fluctuating state. But there was no significant difference between the two groups in PLT, PT, APTT and TT, the difference was not statistically significant (P>0.05). No skin congestion, ecchymosis, hematuria, blood stool were found in all patients.【Conclusion】Early combination of low molecular weight heparin calcium and low molecular dextran can effectively prevent the formation of PVT after splenectomy in patients with PH. Its effect is superior to that of medium-term application, and it is safe and reliable. It is worth popularizing in clinic.
纪福龙,孔彦霞,时丕业. 低分子肝素钙应用时机对门静脉高压脾切除术后门静脉血栓发生的影响[J]. 医学临床研究, 2018, 35(3): 467-470.
JI Fu-long, KONG Yan-xia, SHI Pi-ye. Effect of Low Molecular Weight Heparin Calcium on the Occurrence of Portal Vein Thrombosis (PVT) after Splenectomy in Patients with Portal Hypertension (PH). JOURNAL OF CLINICAL RESEARCH, 2018, 35(3): 467-470.
[1] 陈迅,唐才喜.腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症[J].医学临床研究,2015,(11):2248-2250. [2] 龚红梅.两种低分子肝素在糖尿病患者中应用的效果比较及其护理[J].医学临床研究,2014,(8):1647-1648. [3] 陈佩丽,郭东风,许晓春,等.伊达拉奉联合低分子肝素钙治疗急性脑梗死的临床疗效观察[J].医学临床研究,2012,29(4):761-762. [4] Sarin SK,KhannaR.Non cirrhotic portal hypertension [J].Clin Liver Dis,2014,18(2):451-476. [5] 杨健,钟麟.低分子肝素钙在脾切断流术后预防门静脉血栓形成的临床观察[J].中国药房,2012,(24):2254-2257. [6] 中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治共识[J].中华肝脏病杂志,2008,16(8):564-570. [7] Cheng Z,Yu F,Tian J,et al.A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopicsplenectomy and esophagogastricdevascularization [J].J Thromb Thrombolysis,2015,40(3):294-301. [8] Jiang GQ,Bai DS,Chen P,et al.Predictors of portal vein system thrombosis after laparoseopicsplenectomy and azygoportal disconnection:a retrospective cohort study of 75 consecutive patients with 3-months follow-up[J].Int J Surg,2016,30:143-149. [9] Wu S,Wu Z,Zhang X,et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardialdevascularization[J].Turk J Gastroenteml,2015,26(5):423-428. [10] Wang H,Kopac D,Brisebois R,et al.Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy [J].Can J Surg,2011,54(4):227-231. [11] 曲宇,黄林凤.低分子肝素钙与低分子右旋糖酐对脾切除断流术后门静脉血栓形成及血清D-二聚体水平的影响[J].现代中西医结合杂志,2017,26(1):91-93. [12] Makdissi FF,Herman P,Machado MA,et al.Portal vein thrombosis after esophagogastric devascularization and splenectomy in schistosomal portal hypertension patients:what is the real importance[J].Arg Gastroenterol,2009,46(1):50-56. [13] 郑春雷,赵永福,唐哲,等.早期联合应用抗凝药物预防脾切断流术后门静脉血栓的形成[C].//第六届中原肝病论坛论文集.2015:198-207. [14] 许永庆,赵刚,戴朝六,等.早期应用低分子肝素钙预防断流术后门静脉血栓形成的临床观察[J].实用药物与临床,2013,16(6):476-478. [15] Yang S,He C,Fan X,et al.Early prophylactic anticoagulation via transjugular intrahepatic route for portal vein thrombosis aftersplenectomy in cirrhotic portal hypertension [J].J Vasc Interv Radiol,2015,26(7):1009-1017.
2018, Vol. 35 
