华法林预防肝移植术后人工血管重建的下腔静脉血栓有效性及安全性研究

Efficacy and Safety of Warfarin in Preventing Artificial Vascular Reconstructed Inferior Vena Cava Thrombosis after Liver Transplantation

目的:评估肝脏移植受者使用华法林预防人工血管重建下腔静脉血栓的有效性及安全性。方法:回顾性收集2018年1月到2020年12月在南京鼓楼医院肝胆胰中心行LDLT或接受右半肝的SLT共12名肝脏移植受者的临床资料,对患者INR、人工血管通畅性及出血事件进行分析。结果:肝脏移植术后平均6.5天开始口服华法林,术后1~7、8~14、15~30 d的平均INR分别为1.29(1.22,1.44)、1.71±0.55、1.85±0.69;90、180、360、720、1080 d的INR分别为1.40±0.19、1.35±0.19、1.38±0.15、1.44±0.33、1.34±0.28。9例患者始终保持人工血管通畅,术后30、90、180、360、720、1080 d人工血管累积通畅率分别为100.00%、100.00%、91.67%、81.48%、67.90%、67.90%。抗凝中出血发生率8.33%(1/12),暂停华法林、治疗原发病后好转。结论:肝移植受者使用华法林预防人工血管重建的下腔静脉血栓疗效确切,INR达标对于血栓预防十分重要,尤其是术后早期,建议控制INR 1.5~2.0,抗凝治疗出血发生率低且症状轻微,安全性较高。

Objective:To investigate the efficacy and safety of warfarin in the prevention of thrombosis in vascular graft reconstructed inferior vena cava of liver transplant recipients.Methods:Retrospective analysis was conducted on 12 liver transplant recipients who underwent LDLT or SLT in the Hepatobiliary Pancreatic Center of Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University from January 2018 to December 2020.The INR,patency of artificial vessels and bleeding events were followed.Results:Warfarin was administered on average 6.5 days after operation.The average INR of 1-7 days,8-14 days and 15-30 days after liver transplantation were 1.29(1.22,1.44),1.71±0.55 and 1.85±0.69,respectively.The INR of 90 days,180 days,360 days,720 days and 1080 days after liver transplantation were 1.40±0.19,1.35±0.19,1.38±0.15,1.44±0.33 and 1.34±0.28,respectively.The cumulative patency rates of vascular graft at 30 days,90 days,180 days,360 days,720 days and 1080 days were 100.00%,100.00%,91.67%,81.48%,67.90%and 67.90%,respectively.The incidence of bleeding during anticoagulation was 8.33%(1/12),and the patient was recovered after discontinuing warfarin and etiological treatment.Conclusion:Warfarin can effectively prevent thrombosis of vascular graft reconstructed inferior vena cava after liver transplant.Reaching target INR,which is recommended to be between 1.5 and 2.0,is crucial for thrombosis prevention,especially in the early stage of postoperation.Anticoagulant therapy is safe because of the low incidence of bleeding and mild symptoms.