Risk Factors For Liver Cirrhosis With Portal Vein Thrombosis And The Influences By Anticoagulation Therapy On Esophagogastric Variceal Hemorrhage

Background:Portal vein thrombosis(PVT)is one of the common complication of decompensated liver cirrhosis(LC), the reasons and the specific mechanism are not very clear so far,so investigating the risk factors of portal vein thrombosis may contribute to early detection, prevention and effective treatment of cirrhosis patients with portal vein thrombosis. Now the most common method for thrombosis is anticoagulation therapy, but cirrhosis patients function is poor,so anticoagulation therapy may increase esophagogastric variceal hemorrhage and other complications caused by portal hypertension of cirrhosis patients. Therefore, the clinical use of anticoagulant treatment to portal vein thrombosis is very careful, even patients with portal vein thrombos may not use anticoagulant therapy because of the risk of bleeding. But there are also reports that anticoagulant therapy does not increase the incidence of the upper gastrointestinal bleeding of cirrhosis patients with PVT, and clinical tests show that patients giving anticoagulant therapy after endoscopic variceal sequential therapy do not increase the risk of upper gastrointestinal bleeding. Therefore, Whether giving anticoagulation therapy for liver cirrhosis with portal vein thrombosis is still not unified. Objective:1、Analyzing the clinically relevant information of cirrhosis patients with PVT to explain the associated factors and the independent risk factors of portal vein thrombosis, expecting early detection and prevention of portal vein thrombosis.2、To analysis the influences by anticoagulation therapy on esophagogastric variceal hemorrhage of liver cirrhosis with PVT, discussing the risk factors and preventive measures in order to guide clinical anticoagulant therapy. Method:Review 239 cases of cirrhosis patients diagnosed in our hospital from 2012.1~2012.12, 33 cases of liver cirrhosis combined with PVT patients were thrombosis group, in addition 206 cases of cirrhosis patients without PVT were control group. 10 patients giving anticoagulant therapy of 33 cases of liver cirrhosis with PVT were anticoagulation therapy group, and the other 23 cases were no therapy control group; In the 33 cases of cirrhosis patients with portal vein thrombosis,the 10 patients with esophagogastric variceal hemorrhage were hemorrhagic group, 23 patients without bleeding were not hemorrhage control group.Recording patients normal information(age,gender), and clinical information(etiology, whether there was a history of diabetes and splenectomy, spleen thickness and width of portal vein, the degree of esophageal and gastric varices, with or without portal hypertension and liver ulcer, ascites extent, Child- Pugh score, with or without endoscopic variceal sequential therapy and taking propranolol), as well as laboratory tests including white blood cell(WBC),platelets(PLT), red blood cell(RBC), hemoglobin(HB), fibrinogen(FIB), D- dimer, total bilirubin(TBIL), direct bilirubin(DBIL), albumin(ALB), creatinine(CR) and other datas.Discussing the associated factors and independent risk factors for liver cirrhosis patients with PVT.Using anticoagulant drugs in the treatment of cirrhosis patients with PVT to observate whether upper gastrointestinal bleeding in nearly 1 years to analysis the influences by anticoagulation therapy on esophagogastric variceal hemorrhage,in order to elaborated the risk factors and preventive measures for liver cirrhosis patients with PVT with esophagogastric variceal hemorrhage. Results:1、In totally 239 patients, 33 cases complicated with PVT, morbidity was 13.80%.2、Thrombosis groups and control groups showed no significant difference in age, gender, etiology, Study on white blood cell, red blood cell, hemoglobin, fibrinogen,total bilirubin, direct bilirubin,creatinine, prothrombin time, activated partial prothrombin time,spleen thickness, Child- Pugh score, with or without endoscopic variceal sequential therapy and taking propranolol,there were no significant statistical difference between thrombus group and control group(P>0.05). The albumin level of thrombus group were lower than control group(30.37±4.19g/L VS 32.34±6.08g/L P=0.023), The platelet and width of main portal vein level of thrombus group was higher(113.00(51.00,340.50) VS 55.00(36.75,89.25), P<0.01;1.40(1.20,1.60) VS 1.20(1.10,1.40) P<0.01), the difference were statistically significant. The incidence of diabetes and splenectomy aspects of thrombus group was higher(24.24% VS 7.28%,P<0.01;54.54% VS 16.50%, P<0.01), Analysis of unconditional Logistic regression model indicate that platelet and main portal vein were single hazard factors of PVT in cirrhosis paitients( P=0.009, 0.001;OR:1.006,16.85).3、The analysis of the related factors on esophagogastric variceal hemorrhage of liver cirrhosis with portal vein thrombosis:white blood cell, red blood cell, platelet,hemoglobin, total bilirubin, albumin level, creatinine, prothrombin time, fibrinogen ect, There were no statistical difference, P values were greater than 0.05. The degree of esophageal and gastric varices was a risk factor, P<0.05; endoscopic variceal sequential therapy was a protective factor, the bleeding rates compared with sequential therapy and no treated people was 30% and 73.9% respectively, a significant difference(P <0.05).4、The bleeding rates between anticoagulant therapy group in the use of anticoagulant drugs and no therapy control group was 40% and 26.1% respectively, no significant difference(P>0.05). Conclusion:1、Platelet, albumin, portal vein width, and a history of diaetes or splenectomy were risk factors for cirrhosis patients with PVT, platelet and portal vein width were independent risk factor in cirrhosis patients with PVT, namely the higher the platelet and the wider of main portal vein, the incidence of PVT would be higher.2、The esophagogastric variceal hemorrhage of cirrhosis patients with PVT was closely related to the degree of varicose vein,namely the more severe veins were more prone to lead to upper gastrointestinal bleeding, the endoscopic variceal sequential therapy can significantly reduce the risk of variceal bleeding of cirrhosis patients with PVT.3、Anticoagulant therapy for cirrhosis patients with PVT may not increase esophagogastric variceal hemorrhage incidence.