Abstract | OBJECTIVE: SUMMARY BACKGROUND DATA: METHODS: A total of 50 consecutive cirrhotic patients who underwent laparoscopic splenectomy for hypersplenism were enrolled into this study. From January 2005 to December 2005, 25 cirrhotic patients received no prophylactic anticoagulation therapy after the operation (AT-III [-] group). From January 2006 to July 2006, 25 cirrhotic patients received prophylactic administration of AT-III concentrates (1500 U/d) on postoperative day (POD) 1, 2, and 3 (AT-III [+] group). RESULTS: In AT-III (-) group, 9 (36.0%) patients developed PVT up to POD 7, and risk factors for PVT were identified as: low platelet counts, low AT-III activity, and increased spleen weight. Although there were no significant differences in the clinical characteristics, including the above risk factors, between the 2 groups, only 1 (4.0%) patient developed PVT on POD 30 in AT-III (+) group, and the incidence of PVT was significantly lower than in AT-III (-) group (P = 0.01). In AT-III (-) group, AT-III activity was significantly decreased from POD 1 to POD 7, as compared with the preoperative level, whereas AT-III concentrates prevented the postoperative decrease in AT-III activity. CONCLUSIONS: These results demonstrate that low AT-III activity and further decreases in this activity are associated with PVT after splenectomy in cirrhotic patients, and that treatment with AT-III concentrates is likely to prevent the development of PVT in these patients.
|
Authors | Hirofumi Kawanaka, Tomohiko Akahoshi, Nao Kinjo, Kozou Konishi, Daisuke Yoshida, Go Anegawa, Shohei Yamaguchi, Hideo Uehara, Naotaka Hashimoto, Norifumi Tsutsumi, Morimasa Tomikawa, Yoshihiko Maehara |
Journal | Annals of surgery
(Ann Surg)
Vol. 251
Issue 1
Pg. 76-83
(Jan 2010)
ISSN: 1528-1140 [Electronic] United States |
PMID | 19864937
(Publication Type: Journal Article)
|
Chemical References |
- Anticoagulants
- Fibrin Fibrinogen Degradation Products
- fibrin fragment D
- Antithrombin III
|
Topics |
- Adult
- Aged
- Anticoagulants
(administration & dosage, therapeutic use)
- Antithrombin III
(administration & dosage, analysis)
- Female
- Fibrin Fibrinogen Degradation Products
(analysis)
- Humans
- Hypersplenism
(complications, surgery)
- Infusions, Intravenous
- Laparoscopy
- Liver Cirrhosis
(blood, complications)
- Male
- Middle Aged
- Portal Vein
- Postoperative Care
- Preoperative Care
- Risk Factors
- Splenectomy
(adverse effects)
- Tomography, X-Ray Computed
- Ultrasonography, Doppler
- Venous Thrombosis
(diagnosis, drug therapy, etiology, prevention & control)
|