Effects of early antiplatelet therapy after splenectomy with gastro-oesophageal devascularization.

Jin‐Bao Zhou,Chi‐Wen Liu,Bao‐Yang Luo,Feng Zhu

doi:10.1111/ans.14395

Abstract

BackgroundThis study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro‐oesophageal devascularization.MethodsWe retrospectively analysed 139 patients who underwent splenectomy with gastro‐oesophageal devascularization for portal hypertension due to cirrhosis between April 2010 and December 2016. Based on the post‐operative platelet values, we used two different APT regimens: APT was started when platelet counts were increased to 200 × 109/L or above (group A, n = 64) or 300 × 109/L or above (group B, n = 75). We took note of the patients’ clinical symptoms, operative factors and biochemical indicators.ResultsPlatelet count, mean platelet volume, D‐dimer and pancreatic fistula were closely related to the development of PVT. Early APT was an independent protective factor for PVT. The incidence of post‐operative PVT was 15.1% (21/139) overall, 4.7% (3/64) in group A and 24% (18/75) in group B; there was a significant difference between groups A and B (χ 2 = 10.042, P = 0.002).ConclusionPlatelet count, mean platelet volume, D‐dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastro‐oesophageal devascularization. Selection of the appropriate timing for early APT according to the post‐operative platelet count was feasible. Moreover, the use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT.

Highlights

Transjugular intrahepatic portosystemic shunt and liver transplantation have been gradually applied for the treatment of portal hypertension, splenectomy with gastro-oesophageal devascularization remains the most important modality that can prevent and control the risk for infection and gastrointestinal bleeding, relieve symptoms of hypersplenism, moderate portal vein pressure and improve patients’ quality of life.[1]
The results suggested the efficacy of our method of early antiplatelet therapy (APT), in group A patients in whom the incidence of portal vein thrombosis (PVT) was significantly reduced
APT was an independent protective factor for post-operative PVT occurrence, with odds ratio of

Summary

Introduction

Transjugular intrahepatic portosystemic shunt and liver transplantation have been gradually applied for the treatment of portal hypertension, splenectomy with gastro-oesophageal devascularization remains the most important modality that can prevent and control the risk for infection and gastrointestinal bleeding, relieve symptoms of hypersplenism, moderate portal vein pressure and improve patients’ quality of life.[1]. PVT is potentially fatal by further increasing portal vein pressure and deteriorating liver function, which may increase the risk for upper gastrointestinal bleeding, hepatic coma or even fatal intestinal necrosis.[2] the natural incidence rate of PVT in patients with liver cirrhosis was reported to be 6.6%, which can increase to 18.9% to 57% after splenectomy.[3] it is important to analyse the related risk factors and preventive measures of PVT after splenectomy with gastro-oesophageal devascularization. We aimed to retrospectively study the efficacy of early antiplatelet therapy (APT) for PVT in 139 patients with cirrhosis who underwent splenectomy with gastro-oesophageal devascularization. This study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro-oesophageal devascularization. Conclusion: Platelet count, mean platelet volume, D-dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastrooesophageal devascularization. The use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT

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