利伐沙班对肝硬化失代偿期患者急性门静脉血栓的效果

Effect of rivaroxaban on acute portal vein thrombosis in patients with decompensated cirrhosis

目的探讨利伐沙班对肝硬化失代偿期患者急性门静脉血栓(PVT)的效果。方法选取2017年6月至2018年6月郑州大学第一附属医院收治的8例肝硬化失代偿期合并急性PVT患者,排除肿瘤血栓患者。在常规保肝对症支持治疗的基础上给予患者利伐沙班治疗,未使用其他抗凝和改善循环的药物,每2周进行1次门静脉超声检查。比较再通前和再通后1个月血小板计数(PLT),凝血酶原时间(PT),国际标准化比率(INR),D-二聚体和肝功能,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、总胆红素(TBIL)。结果治疗2、4、6周后PVT完全消失者分别有2、4、2例。PVT在门静脉再通后1个月内未复发。门静脉再通1个月后中位血流速度为14 cm/s。再通后1个月D-二聚体水平低于再通前,差异有统计学意义(P<0.05)。再通后1个月PLT、PT、INR、ALT、AST、ALB、TBIL、门静脉宽度与再通前比较,差异无统计学意义(P>0.05)。结论利伐沙班可有效治疗肝硬化失代偿期患者急性PVT,动态监测D-二聚体对预测门静脉再通意义重大。

Objective To investigate the effect of rivaroxaban on acute portal vein thrombosis (PVT) in patients with decompensated cirrhosis. Methods A total of 8 patients with decompensated cirrhosis complicated with acute PVT were selected from June of 2017 to June of 2018 in the First Affiliated Hospital of Zhengzhou University, excluding tumor thrombus patients. The patients were treated with rivaroxaban on the basis of routine liver protection and symptomatic support treatment. Other anticoagulants and circulation-improving drugs were not administered. Portal vein ultrasound was performed every 2 weeks. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), D-dimer and liver function, including glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), albumin (ALB) and total bilirubin (TBIL) were compared before and 1 month after recanalization. Results After 2, 4 and 6 weeks of treatment, PVT disappeared completely in 2, 4 and 2 cases respectively. PVT didn’t recur within 1 month after portal vein recanalization. One month after portal vein recanalization, the median blood flow velocity was 14 cm/s. One month after recanalization, the level of D-dimer was lower than that before recanalization, and the difference was statistically significant ( P < 0.05). There were no significant differences in PLT, PT, INR, ALT, AST, ALB, TBIL and the width of portal vein between before recanalization and one month after recanalization ( P > 0.05). Conclusion Rivaroxaban could effectively treat acute PVT in patients with liver cirrhosis at decompensation stage. Dynamic monitoring of D-dimer is of great significance for predicting portal vein recanalization.