Gut and Gastroenterology

Abstract

Efficacy of Anticoagulation Therapy in Preventing Portal Vein Thrombosis Based on Blood Coagulation and Fibrinolysis Markers Following Partial Splenic Embolization

Author(s): Toru Ishikawa, Michitaka Imai, Yuichi Kojima, Motoi Azumi, Yujiro Nozawa, Tomoe Sano, Akito Iwanaga, Terasu Honma, Toshiaki Yoshida

Background: This study investigated changes in blood coagulation and fibrinolysis markers and portal vein thrombosis rates in patients who underwent partial splenic embolization (PSE). After PSE, patients with portal hypertension were treated with gabexate mesilate (FOY) or recombinant thrombomodulin (rTM) with the aim of preventing portal vein thrombosis and localized disseminated intravascular coagulation (DIC).
Methods: PSE was performed for portal hypertension, and changes in coagulation markers including thrombin-antithrombin complex (TAT) and plasmin-α2-plasmin inhibitor complex (PIC) were analyzed in 36 patients. Twenty-one patients were treated with FOY, and 15 were treated with rTM. Clinical features, changes in post-PSE blood coagulation and fibrinolysis markers, presence or absence of portal vein thrombosis, and postoperative complications were compared between the groups.
Results: There were no significant differences between the FOY Group and the rTM Group in TAT, PIC, initial platelet count, age, underlying hepatic factors, spleen volume, or splenic infarction rate. In the rTM Group, no significant changes were seen in TAT or PIC before and after PSE, and there was no portal vein thrombosis. In the FOY Group, although there was no significant change in PIC after PSE, a significant elevation was seen in TAT, and portal vein thrombosis was seen in 3 (14.2%) of the 21 patients. Grade 2 vasculitis was seen in two patients in the FOY Group.
Conclusion: Administration of rTM may be a novel, safe, and effective to prevent portal vein thrombosis in PSE patients.


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