肝硬化门静脉血栓形成的抗凝治疗风险与获益评估-国际内科前沿杂志-CSCIED科技核心评价数据库-手机版

肝硬化门静脉血栓形成的抗凝治疗风险与获益评估

Risk and benefit assessment of anticoagulant therapy for portal vein thrombosis in cirrhosis

ES评分 0 浏览量：139 下载量：0

DOI	10.12208/j.ijim.20240002
刊名	国际内科前沿杂志 International Journal of Internal Medicine
年，卷(期)	2024, 5(1)
作者	吴倩,
作者单位	延安大学陕西延安
摘要	门静脉血栓（PVT）是肝硬化患者常见的严重并发症，发生率可达10%-25%，其形成会加剧门静脉高压症进展并加速肝功能失代偿。抗凝治疗在促进血栓溶解和预防复发方面已被证实具有明确疗效，但临床实施需严格权衡出血风险。低分子肝素（LMWH）凭借其稳定的药代动力学特性成为基础抗凝方案，但其剂量方案需依据Child-Pugh分级进行个体化调整；而直接口服抗凝药物（DOACs）的疗效和安全性仍需更多循证医学证据支持。临床决策应整合HAS-BLED评分系统评估出血风险，结合CHA2DS2-VASc评分预测血栓栓塞事件，并通过国际标准化比值（INR）及抗Xa因子活性检测实现治疗方案的动态调整。最新研究进展提示，基于基因多态性分析的个体化给药策略及人工智能辅助决策系统，可能为PVT的精准治疗提供新的研究方向。
Abstract	Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis, with an incidence of 10%-25%. Its formation will aggravate the progression of portal hypertension and accelerate liver decompensation. Anticoagulant therapy has been proven to have a clear effect in promoting thrombolysis and preventing recurrence, but clinical implementation requires strict consideration of bleeding risks. Low molecular weight heparin (LMWH) has become the basic anticoagulant regimen due to its stable pharmacokinetic properties, but its dosage regimen needs to be adjusted individually according to the Child-Pugh classification; while the efficacy and safety of direct oral anticoagulants (DOACs) still need more evidence-based medical support. Clinical decision-making should integrate the HAS-BLED scoring system to assess bleeding risk, combine the CHA2DS2-VASc score to predict thromboembolic events, and dynamically adjust the treatment regimen through the international normalized ratio (INR) and anti-Xa factor activity detection. The latest research progress suggests that individualized drug administration strategies based on gene polymorphism analysis and artificial intelligence-assisted decision-making systems may provide new research directions for the precise treatment of PVT.
关键词	肝硬化门静脉血栓形成；抗凝治疗；风险获益评估；个体化治疗；肝功能监测
KeyWord	Cirrhotic portal vein thrombosis; Anticoagulant therapy; Risk-benefit assessment; Individualized treatment; Liver function monitoring
基金项目
页码	5-10

参考文献
相关文献

[1] Zhang, Zhiqi, et al. "The efficacy and safety of anticoagulants in the treatment of cirrhotic portal vein thrombosis: a systematic review and meta-analysis." Clinical and Applied Thrombosis/Hemostasis 28 (2022): 10760296221104797.

[2] Dong, Shujie, et al. "A systematic review and meta-analysis of anticoagulation therapy for portal vein thrombosis in patients with cirrhosis: to treat or not to treat?." Hepatology International (2021): 1-20.

[3] Gao, Zhanjuan, et al. "Anticoagulation therapy early is safe in portal vein thrombosis patients with acute variceal bleeding: a multi-centric randomized controlled trial." Internal and Emergency Medicine 18.2 (2023): 513-521.

[4] Biolato, Marco, et al. "Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis: What is the evidence?." World Journal of Hepatology 14.4 (2022): 682.

[5] Zhang, Zhiqi, et al. "Safety, efficacy and prognosis of anticoagulant therapy for portal vein thrombosis in cirrhosis: a retrospective cohort study." Thrombosis Journal 21.1 (2023): 13.

[6] Gao, Yanying, et al. "Efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis: A meta-analysis." Clinics and Research in Hepatology and Gastroenterology 45.2 (2021): 101649.

[7] 侯仁惠,李坤,厉国栋,等.肝硬化合并门静脉血栓形成抗凝治疗的研究进展
[J].山东医药, 2022, 62(13):4.

[8] 靳珂珂,丁惠国.肝硬化门静脉血栓形成风险监测及抗凝管理
[J].实用肝脏病杂志, 2024, 27(1):3-6.

[9] 杨盼,高小贤,马冰婕,等.肝硬化,肝癌合并门静脉血栓长期抗凝治疗1例
[J].中国临床案例成果数据库, 2025, 07(01):E0205-E0205.

[10] 刘永刚,薛丹,周嘉迪,等.肝硬化门静脉血栓的诊治思维探讨
[J].中西医结合肝病杂志, 2024, 34(1):56-59.

[11] 卢思竹.肝硬化门静脉血栓形成与肝静脉压力梯度关系及抗凝治疗的效果与安全性分析
[D].南京中医药大学,2024.

[12] 白莆菥,韩文.肝硬化门静脉血栓形成的研究进展
[J].临床医学进展, 2024, 14(4):894-899.

[13] 周宁,冯文娟,汪雨露,等.肝硬化并发门静脉血栓的预测因素及预后分析
[C]//第12届全国疑难及重症肝病大会论文汇编.2023.

[14] 李进军.肝硬化门静脉血栓的预防和治疗
[J].开卷有益（求医问药） 2021年3期, 29-30页, 2021.

[15] 张明.肝硬化门静脉血栓形成诊治新进展
[J].实用肝脏病杂志, 2024, 27(1):11-15.

[16] 冯文娟.肝硬化并发门静脉血栓的危险因素与防护策略
[J].临床肝胆病杂志, 2024(1).

引用本文

吴倩. 肝硬化门静脉血栓形成的抗凝治疗风险与获益评估 [J]. 国际内科前沿杂志. 2024; 5; (1). 5 - 10.

文献评论

相关学者

相关机构