利伐沙班治疗肝硬化门静脉血栓的研究进展

刘双; 赵东强

doi:10.3969/j.issn.1001-5256.2023.07.030

利伐沙班治疗肝硬化门静脉血栓的研究进展

DOI: 10.3969/j.issn.1001-5256.2023.07.030

刘双^{1, 2},
赵东强^2, , ,

1.
河北医科大学研究生院，石家庄 050000
2.
河北医科大学第二医院消化内科，河北省消化病重点实验室，河北省消化病研究所，河北省消化系统疾病临床医学研究中心，石家庄 050000

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：刘双参与选题，负责收集资料，分析资料，撰写文章；赵东强负责选题，拟定写作思路，指导撰写文章并最终定稿。

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通信作者:
赵东强，hbzdq1998@163.com (ORCID：0000-0003-3470-448X)

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出版历程
- 收稿日期: 2022-10-12
- 录用日期: 2022-12-05
- 出版日期: 2023-07-20

Research advances in rivaroxaban in the treatment of portal vein thrombosis in liver cirrhosis

Shuang LIU^{1, 2},
Dongqiang ZHAO^{2
, ,
,}

1.
Graduate School of Hebei Medical University, Shijiazhuang 050000, China
2.
Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang 050000, China

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Corresponding author: ZHAO Dongqiang, hbzdq1998@163.com (ORCID: 0000-0003-3470-448X)

摘要

摘要: 门静脉血栓(PVT)是肝硬化常见并发症之一，与肝病的不良预后有关。新型直接口服抗凝药物利伐沙班通过直接作用于Ⅹa因子的活性中心，抑制凝血酶的生成从而发挥抗栓作用，具有直接口服、无需监测国际标准化比值等优势，是肝硬化PVT长期抗凝治疗的新选择。近年来，越来越多的临床研究表明利伐沙班治疗肝硬化PVT相对安全、有效，但在目前的临床实践中利伐沙班治疗肝硬化PVT的应用经验仍很少，个体化用药方案尚未明确。本文综述了利伐沙班治疗肝硬化PVT的研究进展，以期为肝硬化PVT的临床治疗提供新思路。
- 肝硬化 /
- 利伐沙班 /
- 静脉血栓栓塞 /
- 治疗学
Abstract: Portal vein thrombosis (PVT) is one of the common complications of liver cirrhosis and is associated with the poor prognosis of liver disease. Rivaroxaban, a novel direct oral anticoagulant, exerts an antithrombotic effect by directly acting on the active center of factor Xa to inhibit the generation of thrombin, and it is a new choice for long-term anticoagulant treatment of PVT in liver cirrhosis with the advantages of direct oral administration and no need for international normalized ratio (INR) monitoring. In recent years, more and more clinical studies have shown that rivaroxaban is relatively safe and effective in the treatment of PVT in liver cirrhosis; however, there is still little experience in the application of rivaroxaban in the treatment of PVT in liver cirrhosis in the current clinical practice, and individualized medication regimen remains to be clarified. This article reviews the research advances in rivaroxaban in the treatment of PVT in liver cirrhosis, in order to provide new ideas for the clinical treatment of PVT in liver cirrhosis.
- Liver Cirrhosis /
- Rivaroxaban /
- Venous Thromboembolism /
- Therapeutics

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表 1 利伐沙班治疗肝硬化PVT国内外相关研究进展

Table 1. Research advances in rivaroxaban in the treatment of PVT in liver cirrhosis at home and abroad

第一作者	研究对象	肝硬化程度	抗凝方式	随访时间	再通 [例(%)]	进展 [例(%)]	出血 [例(%)]
He YQ^[26]	肝硬化PVT	Child-Pugh A/B级	利伐沙班组 (n=38) 未抗凝组 (n=49)	6个月	24(63.2) 15(34.9)	3(7.9) 11(25.6)	1(2.6) 0
Coons EM^[33]	肝硬化DVT、PE、PVT或房颤的卒中预防	Child-Pugh A/B/C级: 12/24/8 15/17/9	DOAC组(n=44) 华法林组(n=41)	1年	NA	NA	4(9.1) 6(14.6)
Lee MC^[34]	VTE	NA	利伐沙班组 (n=138) 华法林组 (n=456)	(266.2±111.90)d (328.2±82.12)d	NA	NA	3(1.64) 4(0.88)
Lv Y^[24]	肝硬化PVT	Child-Pugh A/B/C级: 13/25/10 33/27/3 89/164/32	未治疗组(n=48) 抗凝组(n=63, 利伐沙班n=4) TIPS组(n=285)	31.7个月	5(10.4) 23(36.5) 284(99.6)	1(2.0) 3(4.8) 0	9(18.8) 14(22.2) 41(14.4)
Yao W^[30]	肝硬化脾切除术或贲门周围血管离断术后PVT的预防	Child-Pugh B级	利伐沙班组 (n=35) 低分子肝素+华法林组(n=35)	1年	NA	发生PVT 17(48.6) 27(77.1)	1(2.9) 1(2.9)
Du XF^[31]	肝硬化PVT、TIPS术后或布加综合征	Child-Pugh B/C级: 23/3	利伐沙班(n=26)	4个月	NA	NA	0
Ai MH^[21]	肝硬化慢性PVT	Child-Pugh A级	DOAC组(n=40, 利伐沙班n=26) 未抗凝组(n=40)	6个月	11(28.2) 1(2.6)	3(7.7) 4(10.5)	2(5) 1(2.6)
Kang YN^[25]	肝硬化急性PVT	Child-Pugh B/C级: 5/3	利伐沙班(n=8)	1个月	8(100)	0	NA
Hanafy AS^[23]	肝硬化急性PVT	Child-Pugh A/B级	利伐沙班组 (n=40) 华法林组(n=40)	1年	34(85) 18(45)	NA	0 17(43.3)
De Gottardi A^[22]	内脏静脉血栓形成和/或肝硬化	Child-Pugh A/B级	DOAC(n=94, 利伐沙班n=78)	15个月	NA	NA	5(5.3)
Intagliata NM^[32]	肝硬化内脏静脉血栓或房颤	Child-Pugh A/B级: 9/11 9/10	DOAC组(n=20, 利伐沙班n=9) 传统抗凝组 (n=19)	267(172~363)d 478(278~679)d	NA	NA	4(20) 3(16)
注：DVT，深静脉血栓形成；PE，肺栓塞；NA，无数据；VTE，静脉血栓栓塞症；TIPS，经颈静脉肝内门体分流术。

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