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Follow-up results of acute portal and splenic vein thrombosis with or without anticoagulation therapy after hepatobiliary and pancreatic surgery.

Cho CW, Park YJ, Kim YW, Choi SH, Heo JS, Choi DW, Kim DI - Ann Surg Treat Res (2015)

Bottom Line: APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery.Patients' characteristics were not significantly different between the two groups.Further prospective studies of larger patient populations are necessary to confirm our findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery.

Methods: We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups.

Results: APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296).

Conclusion: Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.

No MeSH data available.


Related in: MedlinePlus

Study design and outcomes of anticoagulation and no anticoagulation group. APSVT, acute portal and splenic vein thrombosis; HBP, hepatobiliary and pancreatic; POD, postoperative day.
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Figure 1: Study design and outcomes of anticoagulation and no anticoagulation group. APSVT, acute portal and splenic vein thrombosis; HBP, hepatobiliary and pancreatic; POD, postoperative day.

Mentions: APSVT was diagnosed on CT scan in 148 of 5,295 patients (2.8%) who underwent HBP surgery. After exclusion of sixty-six patients, we finally included 82 patients in this study, of whom 32 received anticoagulation treatment and 50 were observed without anticoagulation (Fig. 1).


Follow-up results of acute portal and splenic vein thrombosis with or without anticoagulation therapy after hepatobiliary and pancreatic surgery.

Cho CW, Park YJ, Kim YW, Choi SH, Heo JS, Choi DW, Kim DI - Ann Surg Treat Res (2015)

Study design and outcomes of anticoagulation and no anticoagulation group. APSVT, acute portal and splenic vein thrombosis; HBP, hepatobiliary and pancreatic; POD, postoperative day.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384288&req=5

Figure 1: Study design and outcomes of anticoagulation and no anticoagulation group. APSVT, acute portal and splenic vein thrombosis; HBP, hepatobiliary and pancreatic; POD, postoperative day.
Mentions: APSVT was diagnosed on CT scan in 148 of 5,295 patients (2.8%) who underwent HBP surgery. After exclusion of sixty-six patients, we finally included 82 patients in this study, of whom 32 received anticoagulation treatment and 50 were observed without anticoagulation (Fig. 1).

Bottom Line: APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery.Patients' characteristics were not significantly different between the two groups.Further prospective studies of larger patient populations are necessary to confirm our findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery.

Methods: We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups.

Results: APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296).

Conclusion: Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.

No MeSH data available.


Related in: MedlinePlus