Abstract: Objective To investigate the risk factors for early portal venous system thrombosis (PVST) after devascularization with splenectomy in cirrhotic patients with portal hypertension and to explore the preventive effects of blood activating, anticoagulation and antiplatelet therapy.Methods A retrospective study was conducted on 320 patients with portal hypertension post liver cirrhosis in our hospital from January 2011 to December 2016. All patients were treated with splenectomy and devascularization, and followed up after operation. Clinical data were collected including the occurrence of PVST. The patients with PVST were treated with blood activating, anticoagulation and antiplatelet therapy (low molecular dextran + vitamin K1 + dipyridamole + warfarin), and the changes of blood coagulation indexes were recorded. Results There were 60 patients developing PVST after operation in the 320 patients with an incidence of 18.8%. Parameters including spleen size, splenic vein diameter, portal vein diameter, flow velocity of portal vein blood, blood transfusion volume, postoperative platelet count and postoperative D-dimer level in PVST group (n=60) were significantly different from those in non-PVST group (n=260) (P<0.05). Multivariate logistic regression analysis showed that the postoperative platelet count, postoperative D-dimer level and blood flow velocity of portal vein were the main independent risk factors for PVST (P<0.05). The area under the receiver-operating characteristic (AUROC) curve of D-dimer for the diagnosis of PVST was 0.794 with 95% confidence interval (CI) of 0.724-0.863 (P<0.05), and the diagnostic cut-off point was 3.55 mg/L. The AUROC curve of postoperative platelet count for the diagnosis of PVST was 0.754 with 95% CI of 0.672~0.836 (P<0.05), and the diagnostic cut-off point was 435.5×10⁹/L. The prothrombin time and activated partial thromboplastin time at month 1 were significantly lower than those at day 1 after operation in PVST group, respectively (9.22±2.13 s vs. 11.67±1.84 s and 35.39±9.14 s vs. 41.94±10.92 s, both P<0.05).Conclusion The occurrence of PVST after devascularization with splenectomy in patients with portal hypertension post liver cirrhosis is common. The postoperative platelet count, postoperative D-dimer and blood flow velocity of portal vein are the main risk factors for the PVST. The blood activating, anticoagulation and antiplatelet therapy might effectively prevent the PVST.

Key words: Liver cirrhosis, Portal hypertension, Devascularization with splenectomy, Portal venous system thrombosis, Risk factors