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王慧珊, 房晔, 叶丝陶, 等. 肝硬化胃静脉曲张合并门静脉血栓患者内镜下组织胶注射治疗后早期抗凝的出血风险评估[J]. 中国临床医学, 2024, 31(3): 361-366. DOI: 10.12025/j.issn.1008-6358.2024.20240547
引用本文: 王慧珊, 房晔, 叶丝陶, 等. 肝硬化胃静脉曲张合并门静脉血栓患者内镜下组织胶注射治疗后早期抗凝的出血风险评估[J]. 中国临床医学, 2024, 31(3): 361-366. DOI: 10.12025/j.issn.1008-6358.2024.20240547
WANG Huishan, FANG Ye, YE Sitao, et al. Assessment of bleeding risk for early anticoagulation after endoscopic cyanoacrylate injection in cirrhosis patients with gastric varices and portal vein thrombosis[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 361-366. DOI: 10.12025/j.issn.1008-6358.2024.20240547
Citation: WANG Huishan, FANG Ye, YE Sitao, et al. Assessment of bleeding risk for early anticoagulation after endoscopic cyanoacrylate injection in cirrhosis patients with gastric varices and portal vein thrombosis[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 361-366. DOI: 10.12025/j.issn.1008-6358.2024.20240547

肝硬化胃静脉曲张合并门静脉血栓患者内镜下组织胶注射治疗后早期抗凝的出血风险评估

Assessment of bleeding risk for early anticoagulation after endoscopic cyanoacrylate injection in cirrhosis patients with gastric varices and portal vein thrombosis

  • 摘要:
    目的 探讨抗凝治疗对肝硬化胃静脉曲张合并门静脉血栓(portal vein thrombosis, PVT)患者内镜下组织胶注射治疗后出血事件的影响。
    方法 纳入2023年1月至2023年12月因胃静脉曲张出血就诊于复旦大学附属中山医院,影像学检查发现PVT,并接受内镜下组织胶注射治疗的患者。收集患者临床资料,根据术后48 h内是否行抗凝治疗,将患者分为抗凝组和非抗凝组。随访6周,评价患者出血情况。采用Cox风险比例回归模型分析术后早期(6周内)出血的影响因素。
    结果 共纳入160例患者,其中65例患者在内镜下组织胶治疗后48 h内接受抗凝治疗。抗凝组和非抗凝组患者性别、肝硬化病因、组织胶和聚桂醇用量、Child-Pugh分级等差异无统计学意义。抗凝组与非抗凝组治疗后6周内出血率差异无统计学意义(1.54% vs 2.10%,P=0.795)。多因素Cox分析显示,组织胶用量多是术后6周内出血的危险因素(HR=5.862,P=0.015)。
    结论 肝硬化胃静脉曲张合并PVT患者接受内镜下组织胶注射治疗后,早期抗凝治疗不增加出血风险,而组织胶用量大可能增加术后出血,结论有待增加样本量验证。

     

    Abstract:
    Objective To explore the effects of anticoagulation treatment to postoperative bleeding events in liver cirrhosis patients with gastric varices and portal vein thrombosis.
    Methods Patients diagnosed with portal vein thrombosis and treated with endoscopic cyanoacrylate injection at Zhongshan Hospital, Fudan University due to gastric variceal bleeding from January 2023 to December 2023 were included. Clinical data of patients were collected, and patients were divided into anticoagulant group and non-anticoagulant group based on whether anticoagulant treatment was performed within 48 h after treatment. Re-bleeding in patients was evaluated in 6 weeks of follow-up. Cox regression was used for univariate and multivariate analysis of re-bleeding within 6 weeks after treatment.
    Results A total of 160 patients were included, of whom 65 patients received anticoagulation treatment within 48 h after endoscopic cyanoacrylate injection. There were no statistically significant differences in gender, etiology of liver cirrhosis, dosage of cyanoacrylate and sclerosing agents, and Child-Pugh grading between the two groups. There was no statistically significant difference in re-bleeding rate within 6 weeks after treatment between the two groups (1.54% vs 1.05%, P=0.795). Multivariate Cox regression analysis showed that the large amount of cyanoacrylate was a risk factor for re-bleeding within 6 weeks after endoscopic treatment (HR=5.862, P=0.015).
    Conclusions For patients with liver cirrhosis, gastric varices, and portal vein thrombosis, who receive endoscopic cyanoacrylate injection, early anticoagulation does not increase the risk of re-bleeding after treatment, while a large amount of cyanoacrylate injection may be a risk factor for re-bleeding. However, sample should be increased to verify.

     

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