Analysis of risk factors for portal venous system thrombosis formation and treatment for patients with posthepatitic cirrhosis complicating portal hypertension after splenectomy and pericardial devascularization

Objective: To analyze the risk factors for portal venous system thrombosis (PVST) formation and the effect of thrombolytic therapy in patients with posthepatitic cirrhosis complicating portal hypertension after splenectomy and pericardial devascularization.

Methods: We retrospectively reviewed our records of 71 patients with posthepatitic cirrhosis complicating portal hypertension who underwent splenectomy and pericardial devascularization at our hospital between January 2005 and December 2011. The 71 patients were divided into three groups: Group A (23 who received anticoagulation therapy in the early period of postoperation), Group B (29 who received anticoagulation therapy when their postoperative platelet count was >300×10⁹/L), and Group C (19 who did not receive postoperative anticoagulation therapy). The incidence of PVST, the anatomic distribution of thrombosis, and the effect of thrombolytic therapy were compared among the three groups and the relationship between PVST and various factors before and during operation was determined.

Results: Multivariate analysis showed that PVST after splenectomy and pericardial devascularization was related to the diameter of main portal vein and low preoperative platelet counts. The total incidence of PVST was 40.8 % (29/71). The incidence of portal venous system thrombosis in Groups A, B and C was 26.1% (6/23), 44.8% (13/29), and 52.6% (10/19), respectively, without obvious differences among these groups. Thrombosis of the portal vein and its branches was found postoperatively. Splenic vein thrombosis accounted for 72.4% of all PVST. The rate of complete resolution of portal and superior mesenteric venous thrombosis was 76.2% (16/21), while that was only 23.8% (5/21) for splenic vein thrombosis (χ²=11.524, P=0.001), which was significantly different from the former (χ²=11.524,P=0.001).

Conclusion: The diameter of main portal vein and low preoperative platelet counts were independent risk factors for PVST in patient with posthepatitic cirrhosis complicating portal hypertension after splenectomy and pericardial devascularization. Preventive anticoagulation therapy does not affect PVST formation. After thrombolytic therapy, the rate of complete resolution of portal and superior mesenteric venous thrombosis is higher than that of splenic vein thrombosis.