Early prophylactic anticoagulation for portal vein system thrombosis after splenectomy: A systematic review and meta-analysis

Zhang,Ning; Yao,Yingmin; Xue,Wanli; Wu,Shengli

doi:10.3892/br.2016.755

Early prophylactic anticoagulation for portal vein system thrombosis after splenectomy: A systematic review and meta-analysis

Authors:
- Ning Zhang
- Yingmin Yao
- Wanli Xue
- Shengli Wu
View Affiliations

Affiliations: Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China, Department of Public Health, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
Published online on: September 9, 2016 https://doi.org/10.3892/br.2016.755
Pages: 483-490

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

A systematic review and meta-analysis were conducted to evaluate the efficacy and safety of early prophylactic anticoagulation for the prevention of portal vein system thrombosis (PVST) after splenectomy. A systematic search of the PubMed, EMBASE, Springer and Cochrane Library databases was performed to identify studies comparing the outcomes in patients receiving or not receiving regular prophylactic anticoagulation after splenectomy. The quality of the included studies was assessed using the Jadad Score and the Newcastle‑Ottawa Scale. Heterogeneity was evaluated using the χ2 and I2 tests. The parameters that were analyzed included the incidence of PVST and anticoagulation‑associated complications. A total of seven studies qualified for the review, involving 383 and 283 patients receiving or not receiving regular prophylactic anticoagulation, respectively. The incidence of PVST was significantly reduced with an odds ratio (OR) of 0.31 [95% confidence interval (CI), 0.21‑0.46; P<0.00001] in the regular prophylactic anticoagulation group compared with the control group. No difference in the incidence of anticoagulation‑associated complications was identified between the two groups (OR=0.60, 95% CI, 0.23‑1.56; P=0.30). Early prophylactic anticoagulation was associated with a reduced incidence of PVST, although it was not associated with the incidence of anticoagulation‑associated complications. These results indicate that prophylactic anticoagulation could be safely administered after splenectomy, even to cirrhotic patients.

View Figures

View References

1	Parikh S, Shah R and Kapoor P: Portal vein thrombosis. Am J Med. 123:111–119. 2010. View Article : Google Scholar : PubMed/NCBI
2	Rattner DW, Ellman L and Warshaw AL: Portal vein thrombosis after elective splenectomy. An underappreciated, potentially lethal syndrome. Arch Surg. 128:565–570. 1993.
3	Stamou KM, Toutouzas KG, Kekis PB, Nakos S, Gafou A, Manouras A, Krespis E, Katsaragakis S and Bramis J: Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric and splenic veins. Arch Surg. 141:663–669. 2006. View Article : Google Scholar : PubMed/NCBI
4	Delaitre B, Champault G, Barrat C, Gossot D, Bresler L, Meyer C, Collet D and Samama G: Laparoscopic splenectomy for hematologic diseases. Study of 275 cases. French society of laparoscopic surgery. Ann Chir. 125:522–529. 2000.(In French).
5	Mesa RA, Nagorney DS, Schwager S, Allred J and Tefferi A: Palliative goals, patient selection and perioperative platelet management: Outcomes and lessons from 3 decades of splenectomy for myelofibrosis with myeloid metaplasia at the Mayo Clinic. Cancer. 107:361–370. 2006. View Article : Google Scholar : PubMed/NCBI
6	van't Riet M, Burger JW, van Muiswinkel JM, Kazemier G, Schipperus MR and Bonjer HJ: Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg. 87:1229–1233. 2000. View Article : Google Scholar : PubMed/NCBI
7	Winslow ER, Brunt LM, Drebin JA, Soper NJ and Klingensmith ME: Portal vein thrombosis after splenectomy. Am J Surg. 184:631–636. 2002. View Article : Google Scholar : PubMed/NCBI
8	Kinjo N, Kawanaka H, Akahoshi T, Tomikawa M, Yamashita N, Konishi K, Tanoue K, Shirabe K, Hashizume M and Maehara Y: Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg. 97:910–916. 2010. View Article : Google Scholar : PubMed/NCBI
9	Northup PG and Intagliata NM: Anticoagulation in cirrhosis patients: What don't we know? Liver Int. 31:4–6. 2011. View Article : Google Scholar : PubMed/NCBI
10	Tripodi A, Primignani M, Chantarangkul V, Dell'Era A, Clerici M, de Franchis R, Colombo M and Mannucci PM: An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 137:2105–2111. 2009. View Article : Google Scholar : PubMed/NCBI
11	Tripodi A and Mannucci PM: The coagulopathy of chronic liver disease. N Engl J Med. 365:147–156. 2011. View Article : Google Scholar : PubMed/NCBI
12	Tripodi A: The coagulopathy of chronic liver disease: Is there a causal relationship with bleeding? No. Eur J Intern Med. 21:65–69. 2010. View Article : Google Scholar : PubMed/NCBI
13	Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ and McQuay HJ: Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 17:1–12. 1996. View Article : Google Scholar : PubMed/NCBI
14	Wells G, Shea B, O'Connell D, et al: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.aspJanuary 26–2016
15	Wang JZ, Liu Y, Wang JL, Lu L, Zhang YF, Lu HW and Li YM: Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis. World J Gastroenterol. 21:7036–7046. 2015.PubMed/NCBI
16	Kawanaka H, Akahoshi T, Kinjo N, Konishi K, Yoshida D, Anegawa G, Yamaguchi S, Uehara H, Hashimoto N, Tsutsumi N, et al: Impact of antithrombin III concentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism. Ann Surg. 251:76–83. 2010. View Article : Google Scholar : PubMed/NCBI
17	Wang H, Kopac D, Brisebois R, Sample C and Shapiro AM: Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy. Can J Surg. 54:227–231. 2011. View Article : Google Scholar : PubMed/NCBI
18	Lai W, Lu SC, Li GY, Li CY, Wu JS, Guo QL, Wang ML and Li N: Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol. 18:3443–3450. 2012. View Article : Google Scholar : PubMed/NCBI
19	Kawanaka H, Akahoshi T, Itoh S, Iguchi T, Harimoto N, Uchiyama H, Yoshizumi T, Shirabe K, Takenaka K and Maehara Y: Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin III concentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg. 219:865–874. 2014. View Article : Google Scholar : PubMed/NCBI
20	Hongwei C, Zhang L, Maoping L, Yong Z, Chengyou D and Dewei L: Era of liver transplantation: Combined anatomic splenectomy and anticoagulant therapy in prevention of portal vein thrombosis after splenectomy. Hepatogastroenterology. 62:405–409. 2015.PubMed/NCBI
21	Svensson M, Wirén M, Kimby E and Hägglund H: Portal vein thrombosis is a common complication following splenectomy in patients with malignant haematological diseases. Eur J Haematol. 77:203–209. 2006. View Article : Google Scholar : PubMed/NCBI
22	Kakinoki K, Okano K, Suto H, Oshima M, Hagiike M, Usuki H, Deguchi A, Masaki T and Suzuki Y: Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis. Surg Today. 4:883–888. 2013. View Article : Google Scholar
23	Romano F, Caprotti R, Conti M, Piacentini MG and Uggeri F, Motta V, Pogliani EM and Uggeri F: Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg. 391:483–488. 2006. View Article : Google Scholar : PubMed/NCBI
24	Krauth MT, Lechner K, Neugebauer EA and Pabinger I: The postoperative splenic/portal vein thrombosis after splenectomy and its prevention-an unresolved issue. Haematologica. 93:1227–1232. 2008. View Article : Google Scholar : PubMed/NCBI
25	Ikeda M, Sekimoto M, Takiguchi S, Kubota M, Ikenaga M, Yamamoto H, Fujiwara Y, Ohue M, Yasuda T, Imamura H, et al: High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan. Ann Surg. 241:208–216. 2005. View Article : Google Scholar : PubMed/NCBI
26	Chaffanjon PC, Brichon PY, Ranchoup Y, Gressin R and Sotto JJ: Portal vein thrombosis following splenectomy for hematologic disease: Prospective study with Doppler color flow imaging. World J Surg. 22:1082–1086. 1998. View Article : Google Scholar : PubMed/NCBI
27	Bach AM, Hann LE, Brown KT, Getrajdman GI, Herman SK, Fong Y and Blumgart LH: Portal vein evaluation with US: Comparison to angiography combined with CT arterial portography. Radiology. 201:149–154. 1996. View Article : Google Scholar : PubMed/NCBI
28	Francoz C, Valla D and Durand F: Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. 57:203–212. 2012. View Article : Google Scholar : PubMed/NCBI
29	Soyer T, Ciftci AO, Tanyel FC, Senocak ME and Büyükpamukçu N: Portal vein thrombosis after splenectomy in pediatric hematologic disease: Risk factors, clinical features, and outcome. J Pediatr Surg. 41:1899–1902. 2006. View Article : Google Scholar : PubMed/NCBI
30	Li MX, Zhang XF, Liu ZW and Lv Y: Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis. Hepatobiliary Pancreat Dis Int. 12:512–519. 2013. View Article : Google Scholar : PubMed/NCBI
31	Qi X, De Stefano V, Li H, Dai J, Guo X and Fan D: Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 26:23–29. 2015. View Article : Google Scholar : PubMed/NCBI
32	Qi X, Bai M, Guo X and Fan D: Pharmacologic prophylaxis of portal venous system thrombosis after splenectomy: A meta-analysis. Gastroenterol Res Pract. 2014:2926892014. View Article : Google Scholar : PubMed/NCBI
33	Ma JC, Zhao J, Su QH, Zhang DH, Guo Y and Ji ZZ: Effects of alprostadil in prevention of portal vein thrombogenesis after splenectomy and devascularization: A clinical observation of 76 patients with portal hypertension. Zhonghua Yi Xue Za Zhi. 88:524–526. 2008.(In Chinese). PubMed/NCBI
34	Xue H, Zhang H, Zhang Y and Jiang Q: Portal anticoagulation in preventing thrombosis after porta-azygous devascularization for portal hypertension. Zhonghua Wai Ke Za Zhi. 38:855–857. 2000.(In Chinese). PubMed/NCBI