[1]樊江浩,王 嘉,万 杰,等.肝硬化门静脉血栓抗凝治疗有效性及安全性Meta分析[J].陕西医学杂志,2023,52(4):487-491.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.028]
 FAN Jianghao,WANG Jia,WAN Jie,et al.Efficacy and safety of anticoagulant therapy for portal vein thrombosis in liver cirrhosis:a meta-analysis[J].,2023,52(4):487-491.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.028]
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肝硬化门静脉血栓抗凝治疗有效性及安全性Meta分析
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年4期
页码:
487-491
栏目:
Meta分析
出版日期:
2023-04-05

文章信息/Info

Title:
Efficacy and safety of anticoagulant therapy for portal vein thrombosis in liver cirrhosis:a meta-analysis
作者:
樊江浩王 嘉万 杰马海艳黄 婷沙小莹王宏利
(西安市第八医院肝病六科,陕西 西安 710061)
Author(s):
FAN JianghaoWANG JiaWAN JieMA HaiyanHUANG TingSHA XiaoyingWANG Hongli
(Sixth Department of Liver Disease,Xi'an Eighth Hospital,Xi'an 710061,China)
关键词:
肝硬化 门静脉血栓 抗凝 出血 有效性 安全性
Keywords:
Liver cirrhosis Portal vein thrombosis Anticoagulation Bleeding Efficacy Safety
分类号:
R 657.31
DOI:
DOI:10.3969/j.issn.1000-7377.2023.04.028
文献标志码:
A
摘要:
目的:采用Meta分析评估肝硬化门静脉血栓(PVT)抗凝治疗的有效性和安全性。方法:计算机检索数据库,收集国内外公开发表的有关抗凝药物治疗肝硬化门静脉血栓的文献。按照研究纳入/排除标准筛选文献,提取研究数据,对文献质量进行评价,该工作由2名研究者独立完成。Meta分析应用Rev Man 5.3软件完成。评估抗凝治疗PV再通率、PVT进展、静脉曲张出血率及任何部位出血率。结果:共纳入6项研究,共计437例PVT患者。Meta分析结果显示:抗凝组与未抗凝组比较PV再通率(RR=2.33,95%CI:1.80~3.02,P<0.00001)及PVT进展(RR=0.50,95%CI:0.29~0.87,P=0.01)差异均具有统计学意义; 而在静脉曲张出血(RR=0.85,95%CI:0.14~5.21,P=0.86)、任何部位出血(RR=0.96,95%CI:0.24~3.83,P=0.96)比较差异不具有统计学意义。结论:抗凝治疗可提高肝硬化患者PV再通率,同时不增加出血风险。
Abstract:
Objective:To evaluate the efficacy and safety of anticoagulant therapy for portal vein thrombosis(PVT)in liver cirrhosis by meta-analysis.Methods:The literature about anticoagulant drugs in the treatment of PVT in liver cirrhosis published at home and abroad was collected by computer search database.According to the study inclusion/exclusion criteria,the literature was screened,the study data were extracted,and the quality of the literature was evaluated by two researchers independently.Meta-analysis was performed by using RevMan 5.3 software.The rate of PV recanalization,progression of PVT,variceal bleeding,and any site bleeding were evaluated.Results:Six studies involving 437 PVT patients were included.The results of meta-analysis showed that there were statistically significant differences in PV recanalization rate(RR=2.33,95%CI:1.80 to 3.02,P<0.00001)and PVT progression(RR=0.50,95%CI:0.29 to 0.87,P=0.01)between the anticoagulation group and the non-anticoagulation group.However,there was no significant difference in variceal bleeding(RR=0.85,95%CI:0.14 to 5.21,P=0.86)and any site bleeding(RR=0.96,95%CI:0.24 to 3.83,P=0.96).Conclusion:Anticoagulant therapy can improve the recanalization rate of PV in patients with liver cirrhosis without increasing the risk of bleeding.

参考文献/References:

[1] Noronha-Ferreira C,Reis D,Cortez-Pinto H,et al.Anticoagulation in cirrhosis and portal vein thrombosis is safe and improves prognosis in advanced cirrhosis[J].Dig Dis Sci,2019,64(9):2671-2683.
[2] Luca A,Caruso S,Milazzo M,et al.Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis[J].Radiology,2012,265(1):124-132.
[3] Delgado MG,Seijo S,Yepes I,et al.Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis[J].Clin Gastroenterol Hepatol,2012,10(7):776-783.
[4] Ai MH,Dong WG,Tan XP,et al.Efficacy and safety study of direct-acting oral anticoagulants for the treatment of chronic portal vein thrombosis in patients with liver cirrhosis[J].Eur J Gastroenterol Hepatol,2020,32(10):1395-1400.
[5] Chen H,Liu L,Qi X,et al.Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis[J].Eur J Gastroenterol Hepatol,2016,28(1):82-89.
[6] Chung JW,Kim GH,Lee JH,et al.Safety,efficacy,and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis:A propensity score matching analysis[J].Clin Mol Hepatol,2014,20(4):384-391.
[7] Pettinari I,Vukotic R,Stefanescu H,et al.Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis[J].Am J Gastroenterol,2019,114(2):258-266.
[8] 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,2017,130(13-14):446-455.
[9] Zhou T,Sun X,Zhou T,et al.Efficacy and safety of nadroparin calcium-warfarin sequential anticoagulation in portal vein thrombosis in cirrhotic patients:A randomized controlled trial[J].Clin Transl Gastroenterol,2020,11(9):e00228.
[10] Lisman T,Porte RJ.Pathogenesis,prevention,and management of bleeding and thrombosis in patients with liver diseases[J].Res Pract Thromb Haemost,2017,1(2):150-161.
[11] Ogren M,Bergqvist D,Björck M,et al.Portal vein thrombosis:prevalence,patient characteristics and lifetime risk:A population study based on 23796 consecutive autopsies[J].World J Gastroenterol,2006,12(13):2115-2119.
[12] Nery F,Chevret S,Condat B,et al.Causes and consequences of portal vein thrombosis in 1243 patients with cirrhosis:Results of a longitudinal study[J].Hepatology,2015,61(2):660-667.
[13] Englesbe MJ,Kubus J,Muhammad W,et al.Portal vein thrombosis and survival in patients with cirrhosis[J].Liver Transpl,2010,16(1):83-90.
[14] Violi F,Corazza GR,Caldwell SH,et al.Portal vein thrombosis relevance on liver cirrhosis:Italian venous thrombotic events registry[J].Intern Emerg Med,2016,11(8):1059-1066.
[15] 祁兴顺,杨 玲.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.
[16] 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.
[17] Qi X,De Stefano V,Li H,et al.Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis:A systematic review and meta-analysis of observational studies[J].Eur J Intern Med,2015,26(1):23-29.
[18] Ghazaleh S,Beran A,Aburayyan K,et al.Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis:A systematic review and meta-analysis[J].Ann Gastroenterol,2021,34(1):104-110.
[19] Werner KT,Sando S,Carey EJ,et al.Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation:Outcome of anticoagulation[J].Dig Dis Sci,2013,58(6):1776-1780.
[20] Chen H,Turon F,Hernández-Gea V,et al.Nontumoral portal vein thrombosis in patients awaiting liver transplantation[J].Liver Transpl,2016,22(3):352-365.
[21] Cerini F,Vilaseca M,Lafoz E,et al.Enoxaparin reduces hepatic vascular resistance and portal pressure in cirrhotic rats[J].J Hepatol,2016,64(4):834-842.
[22] Villa E,Cammà C,Marietta M,et al.Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis[J].Gastroenterology.2012,143(5):1253-1260.
[23] 杨 娟,马 佳,马莉娜.低分子肝素钙预防断流术后门静脉血栓的临床观察[J].陕西医学杂志,2017,46(8):1121-1123.
[24] Intagliata NM,Henry ZH,Maitland H,et al.Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation[J].Dig Dis Sci,2016,61(6):1721-1727.

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备注/Memo

备注/Memo:
基金项目:北京康盟慈善基金会资助项目(B21019BN)
更新日期/Last Update: 2023-04-06