终末期肝病患者股静脉导管相关血栓抗凝治疗后出血相关因素

Analysis of related factors of hemorrhage after anticoagulant therapy for femoral vein catheter-related thrombosis in patients with end-stage liver disease

目的 探讨终末期肝病患者股静脉导管相关血栓抗凝治疗效果及出血相关影响因素。方法 收集2019年1月至2021年5月深圳市第三人民医院62例经股静脉置管后出现导管相关深静脉血栓的终末期肝病住院患者资料。回顾性分析抗凝治疗中出血与不出血患者的临床一般资料及实验室指标,分析影响抗凝至血栓消失时间的相关因素。结果 62例患者中,出血组15例(24.2%),未出血组47例(75.8%)。出血组总抗凝时间为8.0(4.0,22.0)d、FT4为14.6(13.4,17.3)pmol/L,未出血组总抗凝时间为21.0(9.0,42.0)d、FT4为18.0(14.7,21.4)pmol/L,差异均有统计学意义(P<0.05)。多元线性回归分析显示抗凝至血栓消失时间与Cr、抗凝药物种类(低分子肝素组、利伐沙班组、低分子肝素+利伐沙班组、其他组)差异有统计学意义(P<0.05)。结论 终末期肝病患者导管相关深静脉血栓抗凝选择低分子肝素、利伐沙班或者低分子肝素+利伐沙班治疗出血并发症方面无明显差异;FT4可能与抗凝出血相关,Cr与抗凝至血栓消失时间呈负相关;抗凝前关注FT4、Cr等指标,对抗凝出血及血栓消失时间有一定预测作用。

Objective To investigate the efficacy of anticoagulant therapy for femoral vein catheter-related thrombosis in patients with end-stage liver disease(ESLD) and the risk factors of bleeding after treatment. To provide effective scientific basis for anticoagulant therapy for deep venous thrombosis in patients with ESLD. Methods The data of 62 inpatients with ESLD and femoral vein catheter-related thrombosis in our hospital from January 2019 to May 2021 were collected. Clinical general data and laboratory indexes of patients with bleeding and non-bleeding after anticoagulation therapy were analyzed retrospectively;investigating factors associated with the time from anticoagulation to thrombus disappearance. Results A total of 62 patients were enrolled, including 15 cases(24.2%) in bleeding group and 47 cases(75.8%) in non-bleeding group. There were significant differences in total anticoagulation time 8.0(4.0,22.0) vs 21.0(9.0,42.0) days and FT4 14.6(13.4,17.3) vs 18.0(14.7,21.4) pmol/L between bleeding group and non-bleeding group(P<0.05). The result of multiple linear regression showed that the time from anticoagulation to thrombus disappearance was significantly correlated to creatinine(Cr) and anticoagulant drugs(low molecular weight heparin, rivaroxaban, low molecular weight heparin + rivaroxaban or other drugs),(P<0.05). Conclusion There is no significant difference between the choice of anticoagulant drugs(low molecular weight heparin, rivaroxaban or low molecular weight heparin + rivaroxaban) and curative effect in the treatment of bleeding complications in ESLD patients with catheter-related deep vein thrombosis. FT4 may be correlated with anticoagulant bleeding, while Cr is negatively correlated with the time from anticoagulant to thrombus disappearance. Before anticoagulation, it is necessary to pay attention to objective indexes such as FT4 and Cr, which can predict the time of anticoagulation bleeding and thrombus disappearance.