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Thromb Haemost
DOI: 10.1055/a-2484-0747
New Technologies, Diagnostic Tools and Drugs

Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism

Zhaobao Shi   *
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
2   The Yangzhou School of Clinical Medicine of Dalian Medical University, Dalian, Liaoning, China
,
Kunqing Xiao   *
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Tianming Gao   *
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Shengjie Jin
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Chi Zhang
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Baohuan Zhou
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Dousheng Bai
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
,
Guoqing Jiang
1   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
3   Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
› Author Affiliations Funding This study was supported by the National Natural Science Foundation of China (Grant No. 82173353), the Clinical Research Project of Jiangsu Commission of Health (Grant No. K2023002), and the Top Talent Scientific Research Project of “Six One Projects” (Grant No. LGY2018028).
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Abstract

Background Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear.

Objectives The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism.

Methods In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS.

Results We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all P <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all P <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013–0.248; P <0.001).

Conclusion Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.

Keywords

apixaban - aspirin - laparoscopic splenectomy - thrombosis - portal hypertension

Ethical Approval Statement

The study protocol was approved by the Ethics Committee of the Clinical Medical College of Yangzhou University (No. 2020ky178).


Data Availability Statement

The data generated in this study are not publicly available due to the information that could compromise patient privacy, but are available upon reasonable request from the corresponding author.


Patient Consent Statement

We obtained written informed consent from all patients enrolled in the study.


Authors' Contribution

Z.S. and K.X. evaluated the data and composed the initial draft of the manuscript. Z.S. and T.G. collected the data. C.Z. and B.Z. analyzed and reviewed the data. S.J. verified the data. D.B. and G.J. conceived and edited the manuscript. The manuscript was thoroughly revised by all the authors, and each of them reviewed and endorsed the ultimate edition; each author had full access to the entire set of study data. All the authors took the responsibility for making the decision to submit the manuscript for publication.


* These authors contributed equally to this study.




Publication History

Received: 11 September 2024

Accepted: 23 November 2024

Article published online:
13 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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