Effects of early antiplatelet therapy after splenectomy with gastro‐oesophageal devascularization

• Published in: ANZ journal of surgery Vol. 88; no. 10; pp. E725 - E729
• Main Authors: Zhou, Jin‐Bao, Luo, Bao‐Yang, Liu, Chi‐Wen, Zhu, Feng
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2018; Blackwell Publishing Ltd
• Subjects: Antiplatelet therapy; antiplatelet therapy regimen; Aspirin; Cirrhosis; Dimers; Dipyridamole; Esophagus; Fistula; Fistulae; Hepatopancreaticobiliary Surgery; Hypertension; Liver cirrhosis; Pancreas; Patients; Platelets; portal hypertension; Portal vein; portal vein hypertension; Risk analysis; Risk factors; Splenectomy; splenectomy with gastro‐oesophageal devascularization; Therapy; Thromboembolism; Thrombosis; portal vein hypertension; risk factors; splenectomy with gastro-oesophageal devascularization; portal hypertension; antiplatelet therapy regimen
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.14395

Background This study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro‐oesophageal devascularization. Methods We retrospectively analysed 139 patients who underwent splenectomy with gastro‐oesophageal devascularization for portal hypertension due to cirrhosis between April 2010 and December 2016. Based on the post‐operative platelet values, we used two different APT regimens: APT was started when platelet counts were increased to 200 × 109/L or above (group A, n = 64) or 300 × 109/L or above (group B, n = 75). We took note of the patients’ clinical symptoms, operative factors and biochemical indicators. Results Platelet count, mean platelet volume, D‐dimer and pancreatic fistula were closely related to the development of PVT. Early APT was an independent protective factor for PVT. The incidence of post‐operative PVT was 15.1% (21/139) overall, 4.7% (3/64) in group A and 24% (18/75) in group B; there was a significant difference between groups A and B (χ2 = 10.042, P = 0.002). Conclusion Platelet count, mean platelet volume, D‐dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastro‐oesophageal devascularization. Selection of the appropriate timing for early APT according to the post‐operative platelet count was feasible. Moreover, the use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT.