Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism.

IF 5 2区医学 Q1 HEMATOLOGY

Thrombosis and haemostasis Pub Date : 2024-12-13 DOI:10.1055/a-2484-0747

Zhaobao Shi, Kunqing Xiao, Tianming Gao, Shengjie Jin, Chi Zhang, Baohuan Zhou, Dousheng Bai, Guoqing Jiang

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Abstract

Background: Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear.

Objectives: The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism.

Methods: In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS.

Results: We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all P <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all P <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013-0.248; P <0.001).

Conclusion: Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.

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背景：门静脉系统血栓形成（PVST）是脾切除术后常见的并发症，也可能是致命的并发症。预防脾切除术后 PVST 的最佳抗凝剂仍不明确：本研究旨在比较阿哌沙班与阿司匹林在预防肝硬化脾功能亢进腹腔镜脾切除术（LS）后 PVST 的安全性和有效性：在这项单中心随机对照试验中，80名接受LS的肝硬化患者被随机分配到两个治疗组，分别接受阿哌沙班或阿司匹林治疗6个月。主要疗效结果为LS后PVST的形成：我们排除了四名退出研究的患者。与阿司匹林治疗组相比，阿哌沙班治疗组术后6个月内PVST、PVST主支和肝内分支以及脾静脉血栓形成的动态发生率均显著降低（均为P P P 结论：与阿司匹林相比，阿哌沙班治疗组术后6个月内PVST、PVST主支和肝内分支以及脾静脉血栓形成的动态发生率均显著降低：与阿司匹林相比，阿哌沙班可以更早、更有效地预防肝硬化脾功能亢进LS术后的PVST。与阿司匹林相比，阿哌沙班可作为优先选择的治疗方案，从而降低发生 PVST 的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thrombosis and haemostasis 医学-外周血管病

CiteScore

11.90

自引率

9.00%

发文量

140

审稿时长

1 months

期刊介绍： Thrombosis and Haemostasis publishes reports on basic, translational and clinical research dedicated to novel results and highest quality in any area of thrombosis and haemostasis, vascular biology and medicine, inflammation and infection, platelet and leukocyte biology, from genetic, molecular & cellular studies, diagnostic, therapeutic & preventative studies to high-level translational and clinical research. The journal provides position and guideline papers, state-of-the-art papers, expert analysis and commentaries, and dedicated theme issues covering recent developments and key topics in the field.