| Objectives Portal hypertension is a common complication in patients with cirrhosis.Portal hypertension may cause collateral circulation,ascites and splenomegaly.The main collateral circulation includes lower esophageal and fundus gastric varices,abdominal wall varices,and lower rectum varices.Esophageal and gastric varices rupture and hemorrhage is a common and serious complication of liver cirrhosis with high mortality and recurrence rate.Transjugular Intrahepatic Portosystemic Shunt(TIPS)is an effective treatment for reducing portal vein pressure,controlling portal hypertension and related complications.It has been widely developed in recent years and has good clinical effects.In the early stage of TIPS surgery,the stent stenosis rate is high because most of the stents used are bare stents.The appearance of coated stents greatly reduces the risk of stent stenosis or blockage after surgery,but stent blockage can still occur in a considerable number of patients.There is no unified opinion and standard on whether or not anticoagulation should be used after TIPS,as well as the time of anticoagulation,and there is no specific specification on the specific time standard of anticoagulation for patients after TIPS and the appropriate population for anticoagulation therapy.In clinical practice,it is generally believed that long-term application of anticoagulants may have adverse effects on the coagulation function of patients.Patients with cirrhosis have poor coagulation function,and anticoagulant therapy may increase the risk of bleeding.Need TIPS whether postoperative anticoagulation and anticoagulant therapy for the appropriate crowd this clinical problem,this study reviews the postoperative follow-up of patients with TIPS,through statistical analysis of patients with stent blockage cause and the usage of anticoagulant drugs,to discuss the necessity of anticoagulant drugs in postoperative application TIPS,and try to through the analysis of the anticoagulant treatment time and patients treated with anticoagulant therapy to benefit people and time.Methods1.Data collection:a retrospective statistical shandong provincial hospital from 2010 to 2019 lines TIPS surgery in patients with all basic information,lab results,preoperative portal vein pressure,time of postoperative anticoagulation,postoperative data and follow-up of stent is narrow or jam,compare whether stents in patients with narrow or blocked preoperative laboratory examination,postoperative treatment and the relationship between the clinical manifestations.2.Statistical methods:the data using SPSS 25.0 statistical software were analyzed,and the normal distribution of measurement data using mean+/-standard deviation(X+S);Enumeration data were presented as case number(n)and percentage(%).The data of disordered classification variables were tested by chi-square test,and univariate and multivariate analysis were performed by Cox proportional risk regression model.P<0.05 indicates a statistically significant difference.Results(1)A total of 280 patients were included in the study,including 110 patients(39.3%)with stent stenosis or obstruction,and 170 patients(60.7%)with stent unblocked.Of the 110 patients with stent stenosis or occlusion,60(54.5%)occurred 1 year after surgery,26(23.6%)at 2 years,13(11.8%)at 3 years,7(6.4%)at 4 years,3(2.7%)at 6 years,and 1(0.91%)at 10 years after surgery.Among the included patients,the average age of stent stenosis or obstruction was 51.68±12.61 years old,including 75 males and 35 females.Preoperative portal vein patency in 53 patients,partial portal vein stenosis in 43 patients,portal vein occlusion or cavernous change in 12 patients;WBC 4.40±3.20*109/L,PLT 125.80±93.82*109/L,HB 87.85±25.29g/L,AST 38.87±35.11U/L,ALT 27.57±24.52U/L,TBil 23.81±13.75umol/L,ALB 32.10±5.31g/L,CREA 65.36±21.37umol/L,NA+138.85±4.04mmol/L,INR 1.27±0.21,Child-Pugh score was 7.34±1.63,and MelD score was 10.33±3.04.Anticoagulants were used 170.74±328.96 days after surgery.Preoperative portal venous pressure was 27.07±5.75354mmHg,and postoperative portal venous pressure was 1.63±5.18984mmHg.In total,55 patients with stent stenosis or obstruction sustained anticoagulation for 30 days,37 for 90 days,and 32 for 180 days.The average age of patients without stent stenosis or obstruction was 54.12±10.20 years old,including 105 males and 55 females.Preoperative portal vein patency in 90 patients,partial portal vein stenosis in 66 patients,portal vein occlusion or spongiosis in 13 patients;WBC 4.41±3.30*109/L,PLT 103.25±76.16*109/L,HB 89.28±25.73g/L,AST 44.54±100.37U/L,ALT 28.07±39.35U/L,TBil 28.30±19.51umol/L,ALB 32.17±5.34g/L,CREA 67.17±25.74umol/L,NA+138.35±4.78mmol/L,INR 1.32±0.20,Child-Pugh score was 7.51±1.70,and Meld score was 10.53±3.31.Anticoagulants were used for 116.14±266.38 days after surgery.Preoperative portal venous pressure was 27.92±6.52680mmHg,and postoperative portal venous pressure was 18.48±5.70246mmHg.Among the patients without stent stenosis or obstruction,102 patients continued anticoagulation for 30 days,61 patients continued anticoagulation for 90 days,and 42 patients continued anticoagulation for 180 days.After Cox univariate analysis,PLT(P=0.007)and TBIL(P=0.030)were correlated with stent stenosis or obstruction,while no significant correlation was found between Child-Pugh score,MELD score,PVT and other indicators(P&T;0.05).Long-term anticoagulation was defined as continuous anticoagulation for 30,90 or 180 days,and there was no significant correlation between stent blockage and continuous anticoagulation.Logistic regression analysis showed long-term anticoagulation(HR=1.743;95%CI:1.023,2.968;P=0.041)was related to whether the stent was blocked after operation;Cox multivariate analysis showed long-term anticoagulation(HR=1.633;95%CI:1.090,2.448;P=0.017)was related to whether the stent was blocked after surgery.(2)A total of 64 patients were confirmed to have gastrointestinal bleeding during the follow-up,including 47 patients(73.4%)in the stent stenosis or obstruction group and 17 patients(26.6%)in the stent unblocked group.A total of 212 patients were identified with hepatic encephalopathy during follow-up,including 30(42.9%)of those in the stent stenosis or occlusion group and 61(57.5%)of those in the stent patency group.A total of 194 patients were confirmed to have new or aggravated ascites during follow-up,including 14 patients(45.2%)in the stent stenosis or obstruction group and 19 patients(14.6%)in the stent patency group.Chi-square test showed that stent stenosis or obstruction after TIPS was associated with postoperative rebleeding(P<0.001),new onset or aggravation of ascites(P=0.004),and there was no significant correlation with the occurrence of HE(P=0.276).Logistic regression analysis showed all causes of rebleeding(HR=0.123;95%CI:0.053,0.288;P<0.001),HE(HR=3.864;95%CI:1.484,10.061;P=0.006);new or aggravated ascites after surgery(HR=0.226;95%C1:0.089,0.572;P=0.002)were associated with stent stenosis or obstruction.Cox multivariate analysis showed all-cause rebleeding(HR=0.225;95%CI:0.123,0.413;P<0.001),HE(.HR=2.766;95%CI:1.256,6.094;P=0.012),new or aggravated ascites after surgery(HR=0.234;95%CI:0.118,0:464;P&It;0.001)were associated with stent stenosis or obstruction.(3)In order to investigate the relationship between.postoperative anticoagulation time and stent stenosis or obstruction,30,60 and 90 days of continuous anticoagulation were defined as long-term anticoagulation.If 30 days of anticoagulation was defined as a long time of anticoagulation,55(50%)of the patients with stent stenosis or obstruction continued anticoagulation;Of the patients with stent patency,102(60%)continued anticoagulation.If the anticoagulation time of 90 days was defined as long anticoagulation,37 patients(33.6%)with stent stenosis or blockage continued anticoagulation;Of the patients with stent patency,61(35.9%)continued anticoagulation.If 180 days of anticoagulation was defined as long time of anticoagulation,32 patients(29.1%)of patients with stent stenosis or obstruction continued anticoagulation;Of the patients with stent patency,42(24.7%)continued anticoagulation.Univariate analysis showed no significant correlation between anticoagulation after TIPS and stent stenosis or obstruction.Long-term anticoagulation was found to be associated with stent stenosis or blockage after multivariate analysis.Of all 280 patients,3 had no preoperative portal vein status.There were 143 patients with portal vein patency preoperatively,of which 70 had sustained anticoagulation(counted at 30 days),and 73 had not sustained anticoagulation.Among the anticoagulant patients,25 had postoperative blockage(45 had patency),while 28 had postoperative blockage(45 had patency)without anticoagulation(P=0.744).There were 109 patients with partial portal vein thrombosis,74 of them continued anticoagulation(30 days),35 of them did not continue anticoagulation;24 of the anticoagulant patients had postoperative blockage,50 of them were patent;19 of the non-anticoagulant patients had postoperative blockage,16 of them were patent(P=0.029);There were 25 patients with portal vein spongiosis preoperatively,including 13 patients with continuous anticoagulation(based on 30 days)and 12 patients without continuous anticoagulation.There were 6 patients with postoperative blockage and 7 patients with patency,and 6 patients without anticoagulation had postoperative blockage and 6 patients with patency(P=0.848).Conclusion1.Tips Postoperative anticoagulation is a factor influencing whether stent stenosis or blockage occurs after surgery,and continuous anticoagulation treatment for 30 days after surgery can reduce the risk of stent stenosis or blockage in patients.2.Postoperative stent stenosis or blockage is associated with postoperative rebleeding,occurrence of dominant hepatic encephalopathy,new occurrence or aggravation of ascites,which may indicate the status and function of the stent after operation.3.For patients with partial portal vein thrombosis found preoperatively,anticoagulant therapy lasting 30 days after TIPS can effectively prevent stent stenosis or occlusion,while for patients with preoperative portal vein patency,portal vein caverniosis,and preoperative portal vein occlusion,postoperative anticoagulation has no significant effect on stent stenosis or occlusion. |
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