抗凝治疗肝硬化患者并发门静脉血栓的循证医学证据*

门静脉血栓（PVT）对肝硬化患者的预后有着不良的影响，因此需要给予恰当的处理。临床上常用的治疗策略为抗凝治疗，但是考虑到肝硬化伴有PVT患者食管胃底静脉曲张破裂出血的风险比无肝病的原发性PVT患者要高很多，抗凝治疗的选择十分困难。大多指南对于肝硬化并发PVT患者应当如何治疗并未作出明确的推荐。我们通过检索相关临床研究发现，在肝硬化PVT患者应用抗凝药物能获得较高的再通率，而不会显著增加出血的风险，但研究的证据级别普遍较低，需要更多的前瞻性、大样本研究以进一步论证，同时临床应用抗凝治疗时仍需根据患者的具体情况进行个体化的治疗。

Anticoagulant therapy in patients with liver cirrhosis complicated by portal vein thrombosis:evidence-based medicine

Portal vein thrombosis（PVT） should be treated properly because it has an objective effect on the prognosis of patients with cirrhosis. Anticoagulant therapy is commonly used in clinic，but how to make the correct choice of it for patients with risk of variceal bleeding is very hard. The current worldwide guidelines for the management of cirrhosis patients with PVT do not provide a definite recommendation. We retrieved the relevant clinical trials in literatures and found that the application of anticoagulation in cirrhosis patients with PVT was associated with a high rates of recanalization and didn’t increase the risk of gastrointestinal bleeding. The evidences of current research，however，are generally at a very low levels，and more prospective studies with relatively large samples are needed to give a confirmed conclusion. We think the use of anticoagulant therapy should be individualized based on the specific circumstances at present.