Abstract: Objective To explore the value of thromboelastography (TEG) parameters in predicting portal vein thrombosis (PVT) after splenectomy in patients with hepatitis B-related cirrhosis and to identify related influencing factors. Methods This retrospective study included 114 patients with hepatitis B-related cirrhosis who underwent splenectomy at Dazhou integrated TCM & Western Medicine Hospital from January 2022 to June 2024. Patients were divided into thrombosis group (n=63) and non-thrombosis group (n=51) based on postoperative PVT occurrence. Clinical data were collected for analysis. Logistic multivariate regression analysis was used to determine factors influencing PVT formation after splenectomy. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of TEG parameters for PVT formation. Results In patients with hepatitis B-related cirrhosis undergoing splenectomy, preoperative splenic vein diameter, intraoperative transfusion volume, postoperative splenic vein diameter, and fibrinogen levels on days 1, 3, and 5 postoperatively were 1.45±0.42 cm, 454.67±39.43 mL, 1.21±0.32 cm, 3.98±1.21 g/L, 4.21±1.42 g/L, and 3.94±1.65 g/L, respectively. Alpha angles and maximum amplitude (MA) values were 65.32±6.48°, 71.04±7.32°, 64.31±5.34°, 57.34±6.15 mm, 63.34±6.34 mm, and 56.10±6.15 mm, respectively. All these parameters were significantly higher in the thrombosis group compared to the non-thrombosis group (P<0.05). Preoperative platelet count, preoperative D-dimer, and pre- and postoperative portal vein flow velocities in the thrombosis group were 56.02±13.81×10⁹/L, 377.94±38.65 μg/L, 15.45±3.34 cm/s, and 11.59±3.02 cm/s, respectively. Thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer on days 1, 3, and 5 postoperatively were 13.87±1.85 s, 11.98±1.32 s, 14.01±1.62 s, 32.84±2.78 s, 26.89±2.67 s, 31.69±2.11 s, 12.02±2.64 s, 10.67±1.84 s, and 13.05±2.08 s, respectively. Postoperative D-dimer concentrations on days 1, 3, and 5 were 2.01±0.81 mg/L, 2.79±0.95 mg/L, and 1.68±0.66 mg/L, respectively. Coagulation indices K and R values were 3.07±1.11 min, 1.98±0.74 min, 2.73±1.04 min, 4.42±0.98 min, 3.79±0.81 min, and 4.19±0.89 min, respectively. These parameters were significantly lower in the thrombosis group than in the non-thrombosis group (P<0.05). Logistic regression analysis revealed that preoperative splenic vein diameter and α-angle were independent risk factors for postoperative portal vein thrombosis (OR=5.771, 1.392), while preoperative platelet count, preoperative portal vein velocity, K, R, and MA were independent protective factors (OR=0.948, 0.683, 0.407, 0.365, 0.210). Among the thromboelastography (TEG) parameters, the α-angle demonstrated the highest predictive value for thrombosis, with a sensitivity of 82.5%, specificity of 82.4%, and an area under the curve (AUC) of 0.865. Combined detection achieved a sensitivity of 90.5% and a specificity of 94.1%, with an AUC of 0.963. Conclusion The TEG parameters α-angle and MA are important indicators for predicting PVT formation after splenectomy in patients with hepatitis B-related cirrhosis. This study confirms that preoperative splenic vein diameter and postoperative TEG parameters such as α-angle, K, R, and MA are independent factors influencing PVT formation. The combined use of these TEG parameters can enhance the accuracy of PVT predictions, thus providing more effective risk assessment and management strategies in clinical practice.

Key words: Hepatitis B, Cirrhosis, Splenectomy, Portal Vein Thrombosis, Thromboelastography, Predictive Model