Comparison of Fondaparinux and Low-Molecular-Weight Heparin in the Treatment of Portal Vein Thrombosis in Cirrhosis |
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| Institution: | 1. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology;2. Unit of Internal Medicine and Hepatology, Department of Medicine-DIMED;3. Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy;1. Professor of Medical Science, Brown University, Providence, RI;2. Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School;3. Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Mass;1. Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio;2. Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio;3. Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron Genera, Akron, Ohio;1. Department of Medicine, Baylor College of Medicine, Houston, Tex;2. Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Tex;3. Global Tuberculosis Program, Texas Children''s Hospital, Houston, Tex;4. William T. Shearer Center for Human Immunobiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex;5. National Cancer Institute, Center for Cancer Research, HIV/AIDS Malignancy Branch, Bethesda, Md;6. Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Tex;7. Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex;8. Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Safety, and Effectiveness (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Tex;1. Internal Medicine Department;2. Emergency Medicine Department;3. Cardiology Department, Kaiser Permanente Santa Clara Medical Center, Santa Clara, Calif |
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| Abstract: | BackgroundPortal vein thrombosis is the most common thrombotic complication in cirrhosis. About 60% of anticoagulated patients can achieve recanalization. Despite fondaparinux (FPX) theoretical advantages, data are lacking about safety and efficacy for treatment of portal vein thrombosis in cirrhosis.MethodsCirrhotic patients with portal vein thrombosis treated with FPX or low-molecular-weight heparin (LMWH) were retrospectively included. The extension of thrombosis at baseline and its evolution during anticoagulant treatment were evaluated. Patients were treated with LMWH or FPX at therapeutic dosage and reduction was considered in selected cases.ResultsThere were 124 patients included. Main portal vein branch, splenic, and superior mesenteric veins were involved in 84%, 13%, and 36% of cases, respectively. Forty-one patients (33%) were treated with FPX and 83 (67%) with LMWH. The probability of resolution of thrombosis at 36 months was significantly higher in patients treated with FPX than in those treated with LMWH (77% vs 51%; P = .001), particularly when prescribed at reduced dose. With multivariate analysis, the treatment with FPX (hazard ratio 2.38; P = .002) and use of a full dose (hazard ratio 1.78; P = .035) were independent predictors of portal vein full recanalization. Bleeding rate was higher in patients treated with FPX than in those treated with LMWH (27% vs 13%; P = .06).ConclusionsFPX appears to be more effective than LMWH in the treatment of portal vein thrombosis when used at reduced dose, also in complete thrombosis. FPX should be considered among possible treatments for portal vein thrombosis in cirrhosis. |
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