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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 8
Aug.  2022
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Article Contents

Research advances in the treatment of portal vein thrombosis and gastrointestinal bleeding in patients with liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.08.036
Research funding:

Natural Science Foundation of Gansu Province (21JR1RA085);

Chinese Foundation for Hepatitis Prevention and Control-TianQing Liver Disease Research Fund (TQGB20190261);

Hospital Fund of the First Hospital of Lanzhou University (ldyyyn2017-31)

More Information
  • Corresponding author: CHEN Lin, chenlinfree@126.com(ORCID:0000-0003-1237-5267)
  • Received Date: 2021-12-31
  • Accepted Date: 2022-02-18
  • Published Date: 2022-08-20
  • Portal vein thrombosis (PVT) in patients with liver cirrhosis has attracted more and more attention in recent years, and it can increase portal venous pressure in patients with liver cirrhosis, aggravate esophageal and gastric varices, and even lead to rupture and bleeding. This article reviews the advances in the epidemiology, mechanism, and treatment of PVT with gastrointestinal bleeding in patients with liver cirrhosis under different conditions in China and globally. There are still controversies over the specific treatment method for PVT with gastrointestinal bleeding and the dose and course of anticoagulants at home and abroad, and a large number of high-evidence studies are still needed to clarify the detailed treatment methods for such diseases in the future.

     

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  • [1]
    FACCIA M, AINORA ME, PONZIANI FR, et al. Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate[J]. World J Gastroenterol, 2019, 25(31): 4437-4451. DOI: 10.3748/wjg.v25.i31.4437.
    [2]
    O 'LEARY JG, GREENBERG CS, PATTON HM, et al. AGA clinical practice update: coagulation in cirrhosis[J]. Gastroenterology, 2019, 157(1): 34-43. e1. DOI: 10.1053/j.gastro.2019.03.070.
    [3]
    STINE JG, WANG J, SHAH PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study[J]. Liver Int, 2018, 38(1): 94-101. DOI: 10.1111/liv.13500.
    [4]
    QI X, HAN G, YE C, et al. Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients[J]. Med Sci Monit, 2016, 22: 2528-2550. DOI: 10.12659/msm.898866.
    [5]
    XIAN J, TANG Y, SHAO H, et al. Effect of portal vein thrombosis on the prognosis of patients with cirrhosis without a liver transplant: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2021, 100(16): e25439. DOI: 10.1097/MD.0000000000025439.
    [6]
    WU YM, HU JY, XU LP, et al. Clinical efficacy of gastroscopic and sequential laparoscopic therapy in the treatment of gastric variceal bleeding[J]. Chin J Dig Surg, 2020, 19(6): 653-659. DOI: 10.3760/cma.j.cn115610-20200402-00223.

    吴一鸣, 胡洁云, 徐鹿平, 等. 胃镜腹腔镜序贯疗法治疗胃底静脉曲张破裂出血的临床疗效[J]. 中华消化外科杂志, 2020, 19(6): 653-659. DOI: 10.3760/cma.j.cn115610-20200402-00223.
    [7]
    REGNAULT H, EMAMBUX S, LECOMTE T, et al. Clinical outcome of portal vein thrombosis in patients with digestive cancers: A large AGEO multicenter study[J]. Dig Liver Dis, 2018, 50(3): 285-290. DOI: 10.1016/j.dld.2017.11.001.
    [8]
    RODRÍGUEZ-CASTRO KI, PORTE RJ, NADAL E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review[J]. Transplantation, 2012, 94(11): 1145-1153. DOI: 10.1097/TP.0b013e31826e8e53.
    [9]
    LLOP E, SEIJO S. Treatment of non-cirrhotic, non-tumoural portal vein thrombosis[J]. Gastroenterol Hepatol, 2016, 39(6): 403-410. DOI: 10.1016/j.gastrohep.2015.09.007.
    [10]
    PONZIANI FR, ZOCCO MA, GARCOVICH M, et al. What we should know about portal vein thrombosis in cirrhotic patients: a changing perspective[J]. World J Gastroenterol, 2012, 18(36): 5014-5020. DOI: 10.3748/wjg.v18.i36.5014.
    [11]
    MCDONALD SA, BARCLAY ST, HUTCHINSON SJ, et al. Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005-2016: a national database linkage study[J]. Aliment Pharmacol Ther, 2019, 50(4): 425-434. DOI: 10.1111/apt.15320.
    [12]
    OROSZ E, PATEL P, PYRSOPOULOS N. A national survey of the prevalence and demographics of gastrointestinal bleeding in cirrhotic patients[J]. Am J Gastroenterol, 2018, 113(suppl): S319. DOI: 10.14309/00000434-201810001-00557.
    [13]
    INTAGLIATA NM, ARGO CK, STINE JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: proceedings of the 7th International Coagulation in Liver Disease Conference[J]. Thromb Haemost, 2018, 118(8): 1491-1506. DOI: 10.1055/s-0038-1666861.
    [14]
    HUANG ZY, GAO JH. Protect the portal vein: From pathophysiology to clinical decision making[J]. J Clin Hepatol, 2021, 37(12): 2760-2763. DOI: 10.3969/j.issn.1001-5256.2021.12.003.

    黄志寅, 高锦航. 保护门静脉——从病理生理到临床处理决策[J]. 临床肝胆病杂志, 2021, 37(12): 2760-2763. DOI: 10.3969/j.issn.1001-5256.2021.12.003.
    [15]
    IWAKIRI Y. Pathophysiology of portal hypertension[J]. Clin Liver Dis, 2014, 18(2): 281-291. DOI: 10.1016/j.cld.2013.12.001.
    [16]
    JOIST JH. AICF and DIC in liver cirrhosis: expressions of a hypercoagulable state[J]. Am J Gastroenterol, 1999, 94(10): 2801-2803. DOI: 10.1111/j.1572-0241.1999.02801.x.
    [17]
    RANGASWAMY C, MAILER RK, ENGLERT H, et al. The contact system in liver injury[J]. Semin Immunopathol, 2021, 43(4): 507-517. DOI: 10.1007/s00281-021-00876-7.
    [18]
    DRIEVER EG, von MEIJENFELDT FA, ADELMEIJER J, et al. Nonmalignant portal vein thrombi in patients with cirrhosis consist of intimal fibrosis with or without a fibrin-rich thrombus[J]. Hepatology, 2022, 75(4): 898-911. DOI: 10.1002/hep.32169.
    [19]
    REN BB, YANG J, AN WH, et al. Clinical characteristics of portal vein thrombosis in different types of cirrhosis[J]. Chin J Clin Res, 2021, 34(2): 164-168, 173. DOI: 10.13429/j.cnki.cjcr.2021.02.005.

    任蓓蓓, 杨婧, 安文慧, 等. 不同分型的肝硬化门静脉血栓的临床特点[J]. 中国临床研究, 2021, 34(2): 164-168, 173. DOI: 10.13429/j.cnki.cjcr.2021.02.005.
    [20]
    Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis(2020, Shanghai)[J]. J Clin Hepatol, 2020, 36(12): 2667-2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.

    中华医学会消化病学分会肝胆疾病学组. 肝硬化门静脉血栓管理专家共识(2020年, 上海)[J]. 临床肝胆病杂志, 2020, 36(12): 2667-2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.
    [21]
    LOFFREDO L, PASTORI D, FARCOMENI A, et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and Meta-analysis[J]. Gastroenterology, 2017, 153(2): 480-487. e1. DOI: 10.1053/j.gastro.2017.04.042.
    [22]
    SUMMERS KL, DAVIS KA, NISLY SA. Bleeding risk of therapeutic unfractionated heparin and low molecular weight heparin in patients with cirrhosis[J]. Clin Drug Investig, 2020, 40(2): 191-196. DOI: 10.1007/s40261-019-00875-5.
    [23]
    SENZOLO M, PIANO S, SHALABY S, et al. Comparison of fondaparinux and low-molecular-weight heparin in the treatment of portal vein thrombosis in cirrhosis[J]. Am J Med, 2021, 134(10): 1278-1285. e2. DOI: 10.1016/j.amjmed.2021.05.013.
    [24]
    de GOTTARDI A, TREBICKA J, KLINGER C, et al. Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis[J]. Liver Int, 2017, 37(5): 694-699. DOI: 10.1111/liv.13285.
    [25]
    TOYODA J, MORIOKA D, HORⅡ N, et al. Treatment of acute exacerbation of liver-cirrhosis-associated portal vein thrombosis with direct-acting oral anticoagulant, edoxaban, used as an initial treatment in the early postoperative period after abdominal surgery: a case report[J]. J Med Case Rep, 2021, 15(1): 52. DOI: 10.1186/s13256-020-02651-y.
    [26]
    SCHEINER B, STAMMET PR, POKORNY S, et al. Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function[J]. Wien Klin Wochenschr, 2018, 130(13-14): 446-455. DOI: 10.1007/s00508-018-1351-y.
    [27]
    YAO W, FENG Y, LIU T, et al. Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial[J]. EXCLI J, 2021, 20: 537-549. DOI: 10.17179/excli2020-3120.
    [28]
    GALANTE A, de GOTTARDI A. Portal vein thrombosis: an overview of current treatment options[J]. Acta Gastroenterol Belg, 2021, 84(2): 327-332. DOI: 10.51821/84.2.327.
    [29]
    SEMMLER G, POMEJ K, BAUER D, et al. Safety of direct oral anticoagulants in patients with advanced liver disease[J]. Liver Int, 2021, 41(9): 2159-2170. DOI: 10.1111/liv.14992.
    [30]
    CISAK KI, ASANTE D, GRILL DE, et al. Efficacy and safety of direct oral anticoagulants in patients with cirrhosis-single institution experience[J]. Blood, 2018, 132(Suppl 1): 2525. DOI: 10.1182/blood-2018-99-117607.
    [31]
    SHI W. Effect and safety of different doses of low molecular weight heparin prophylactic anticoagulant therapy on portal vein thrombosis after laparoscopic splenectomy combined with pericardial devascularization[J]. Chin J Thromb Hemost, 2022, 28(2): 2. DOI: 10.3969/j.issn.1009-6213.2022.02.047.

    史维. 低相对分子质量肝素不同剂量预防性抗凝治疗对腹腔镜脾切除联合贲门周围血管离断术后门静脉血栓形成的作用与安全性[J]. 血栓与止血学, 2022, 28(2): 2. DOI: 10.3969/j.issn.1009-6213.2022.02.047.
    [32]
    LENZ K, DIEPLINGER B, BUDER R, et al. Successful treatment of partial portal vein thrombosis (PVT) with low dose rivaroxaban[J]. Z Gastroenterol, 2014, 52(10): 1175-1177. DOI: 10.1055/s-0034-1385171.
    [33]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Vascular diseases of the liver[J]. J Hepatol, 2016, 64(1): 179-202. DOI: 10.1016/j.jhep.2015.07.040.
    [34]
    GUPTA S, HIDALGO J, SINGH B, et al. Usage of direct acting oral anticoagulants in cirrhotic and non-cirrhotic portal vein thrombosis: a systematic review[J]. Cureus, 2021, 13(8): e16922. DOI: 10.7759/cureus.16922.
    [35]
    O'SHEA RS, DAVITKOV P, KO CW, et al. AGA clinical practice guideline on the management of coagulation disorders in patients with cirrhosis[J]. Gastroenterology, 2021, 161(5): 1615-1627. e1. DOI: 10.1053/j.gastro.2021.08.015.
    [36]
    Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association, Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
    [37]
    YOON KT, LIU H, LEE SS. β-blockers in advanced cirrhosis: More friend than enemy[J]. Clin Mol Hepatol, 2021, 27(3): 425-436. DOI: 10.3350/cmh.2020.0234.
    [38]
    BIANCHINI M, CAVANI G, BONACCORSO A, et al. Low molecular weight heparin does not increase bleeding and mortality post-endoscopic variceal band ligation in cirrhotic patients[J]. Liver Int, 2018, 38(7): 1253-1262. DOI: 10.1111/liv.13728.
    [39]
    LI LN, SUN XY, WANG GC, et al. Transjugular intrahepatic portosystemic shunt prevents rebleeding in cirrhotic patients having cavernous transformation of the portal vein without improving their survival[J]. J Dig Dis, 2019, 20(2): 89-96. DOI: 10.1111/1751-2980.12702.
    [40]
    SAUERBRUCH T, MENGEL M, DOLLINGER M, et al. Prevention of rebleeding from esophageal varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy[J]. Gastroenterology, 2015, 149(3): 660-668. e1. DOI: 10.1053/j.gastro.2015.05.011.
    [41]
    DELTENRE P, TRÉPO E, RUDLER M, et al. Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials[J]. Eur J Gastroenterol Hepatol, 2015, 27(9): e1-e9. DOI: 10.1097/MEG.0000000000000403.
    [42]
    LUO X, WANG Z, TSAUO J, et al. Advanced cirrhosis combined with portal vein thrombosis: a randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding[J]. Radiology, 2015, 276(1): 286-293. DOI: 10.1148/radiol.15141252.
    [43]
    LI ZP, WANG GC, ZHANG CQ. Value of transjugular intrahepatic portosystemic shunt in the prevention of esophageal variceal rebleeding in patients with portal vein thrombosis after splenectomy[J]. J Clin Hepatol, 2021, 37(6): 1331-1335. DOI: 10.3969/j.issn.1001-5256.2021.06.023.

    李赵鹏, 王广川, 张春清. 经颈静脉肝内门体分流术对脾切除术后门静脉血栓患者食管静脉曲张再出血的预防价值[J]. 临床肝胆病杂志, 2021, 37(6): 1331-1335. DOI: 10.3969/j.issn.1001-5256.2021.06.023.
    [44]
    SU AP, ZHANG ZD, TIAN BL, et al. Transjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleeding[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(2): 169-175. DOI: 10.1016/s1499-3872(16)60129-7.
    [45]
    PACHECO D, MARCOS JL, PINTO P, et al. Long term results of periesophagogastric devascularization (Han technique) for esophagogastric variceal bleeding and portal thrombosis[J]. Cir Esp, 2017, 95(1): 54-56. DOI: 10.1016/j.ciresp.2016.05.006.
    [46]
    CAIANO LM, RIVA N, CARRIER M, et al. Treatment of portal vein thrombosis: an updated narrative review[J]. Minerva Med, 2021, 112(6): 713-725. DOI: 10.23736/S0026-4806.21.07526-1.
    [47]
    COLLI A, GANA JC, YAP J, et al. Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis[J]. Cochrane Database Syst Rev, 2017, 4: CD008759. DOI: 10.1002/14651858.CD008759.pub2.
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