Prevention And Treatment Of Complications Of Anticoagulation Therapy In Patients With Partial Splenic Embolization

Background:When portal hypertension occurs on the basis of liver cirrhosis,it is often accompanied by hypersplenism of the spleen.Platelets,white blood cells,and even red blood cells are significantly reduced.The patient is prone to bleeding,subcutaneous ecchymosis,menorrhagia,and spontaneous peritonitis.Partial splenic embolization is one of the treatments for portal hypertension splenomegaly and can effectively improve the performance of hypersplenism.However,some postoperative complications,especially portal vein thrombosis,can lead to changes in portal vein blood flow,and even reduce hepatic blood flow,aggravate liver damage,and even severely endanger the lives of patients.The use of small-scale or fractional embolization of the splenic artery to reduce the incidence of postoperative complications of splenic artery embolization,but the clinical significance of whether early anticoagulation can prevent postoperative complications is not yet clear.Purpose:To compare and analyze the change of blood cells and biochemical indexes and the postoperative complications of anticoagulation with low molecular weight heparin combined with warfarin after partial splenic artery embolization,and to explore the clinical value of anticoagulant therapy in preventing and treating postoperative complications of partial splenic artery embolization.Material and methods:Retrospective analysis of patients with partial splenic embolization at Department of Gastroenterology at the Second Affiliated Hospital of Nanchang University from 2012.01 to 2017.08,which were all diagnosed as hypersplenism with cirrhosis and hypersplenism by imaging and/or endoscopy combined with other clinical biochemical indicators.In addition to routine anti-inflammatory treatment for a week,the observation group was also given subcutaneous injection of 4100 units of low-molecular-weight heparin twice a day,while taking oral warfarin 2.5mg once daily,low molecular heparin was discontinued after 3 days.Warfarin maintained treatment for 3 months during which time the international normalized rate(INR)was adjusted to adjust the amount of warfarin,and the INR was maintained between 1.8 and 2.5.Patients with partial splenic embolization who did not receive anticoagulation during the same period served as control group.The general data,history characteristics,hematology indexes,serum biochemical indexes,and postoperative complications of these patients were collected,and then SPSS22.0 software was used for statistical analysis.Results:A total of 71 patients underwent partial splenic artery embolization.50 patients in the observation group examined WBC and PLT at 1 month after treatment,which was significantly higher than before treatment.The difference was statistically significant(P<0.05);the Hb count did not increase significantly compared with that before treatment,and the difference was not statistically significant.Significance(P>0.05).After treatment,ALB,TBIL,ALT and AST showed no significant increase compared with those before treatment,and the difference was not statistically significant(P>0.05).In the observation group,50 patients suffered from various degrees of complications in a short period of time,including 39 cases of fever and 39 cases of pain in the spleen area.One side and/or bilateral pleural effusion occurred in 12 cases with or without left side Pneumonia;1 case of refractory ascites;1 case of portal vein thrombosis.After active symptomatic treatment,the above-mentioned complications were improved without serious consequences.No significant bleeding was observed for 3 months and the prognosis was good.In the control group,postoperative hypersplenism was significantly improved in 21 cases.There was no significant difference in fever and spleen pain compared with the observation group(P>0.05).However,there were 4 cases of portal vein thrombosis in the control group and it was difficult to control.Ascites in 5 cases,compared with the observation group was significantly different(P <0.05).Conclusion:Partial splenic embolization is effective in the treatment of cirrhosis with portal hypertensive splenomegaly,and early postoperative prophylactic anticoagulant therapy can effectively reduce postoperative serious complications,does not increase the risk of bleeding events,and has a good prognosis.The clinical safety of the surgery is improved,and on the basis of understanding the indications and skilled operations,it is worthy of clinical promotion.