Surgery · 2026
Apixaban in preventing portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection for cirrhosis: A single-arm trial.
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Chen Chen, Gao Tianming, Wan Baoyu, Zhou Liuxin, Ding Sheng, Dong Hao, Shi Zhaobao, Cai Jinhong, Jin Shengjie, Zhang Chi, Zhou Baohuan, Bai Dousheng, Jiang Guoqing
Аннотация
BACKGROUND: Portal vein system thrombosis is a prevalent and possibly fatal concurrent disorder after splenectomy. Determining the optimal prophylactic anticoagulation therapy to prevent portal vein system thrombosis is an unresolved clinical question. This study aimed to evaluate the performance of apixaban compared with aspirin in preventing portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection in cirrhotic patients with portal hypertensive bleeding and hypersplenism.
METHODS: In this single-arm trial, 65 consecutive patients received apixaban starting on postoperative day 3 for 6 months. Historical control patients from our previous randomized trial included 38 patients treated with aspirin. Portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis were assessed via imaging at postoperative day 7 and postoperative months 1, 3, and 6.
RESULTS: Generalized estimating equations confirmed that apixaban was associated with earlier and greater reductions in portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis events compared with aspirin, respectively (W = 10.773, P = .013; W = 9.517, P = .023; W = 10.309, P = .016). The incidences of portal vein system thrombosis in the apixaban group not only decreased progressively but were also significantly lower than those in the aspirin group at postoperative months 1 (23.4% vs 60.5%), 3 (14.1% vs 60.5%), and 6 (7.8% vs 36.8%) (all P < .05). Multivariate analysis identified apixaban as an independent protective factor against portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis (all P < .05).
CONCLUSION: Apixaban was associated with a lower risk of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection in cirrhotic patients compared with aspirin, suggesting its potential utility for prophylaxis in this population.
METHODS: In this single-arm trial, 65 consecutive patients received apixaban starting on postoperative day 3 for 6 months. Historical control patients from our previous randomized trial included 38 patients treated with aspirin. Portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis were assessed via imaging at postoperative day 7 and postoperative months 1, 3, and 6.
RESULTS: Generalized estimating equations confirmed that apixaban was associated with earlier and greater reductions in portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis events compared with aspirin, respectively (W = 10.773, P = .013; W = 9.517, P = .023; W = 10.309, P = .016). The incidences of portal vein system thrombosis in the apixaban group not only decreased progressively but were also significantly lower than those in the aspirin group at postoperative months 1 (23.4% vs 60.5%), 3 (14.1% vs 60.5%), and 6 (7.8% vs 36.8%) (all P < .05). Multivariate analysis identified apixaban as an independent protective factor against portal vein system thrombosis, main and intrahepatic branches of portal vein system thrombosis, and splenic vein thrombosis (all P < .05).
CONCLUSION: Apixaban was associated with a lower risk of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection in cirrhotic patients compared with aspirin, suggesting its potential utility for prophylaxis in this population.