Impacto da anticoagulação pré-operatória em pacientes com trombose de veia porta submetidos ao transplante hepático

Abstract

Introduction: Portal vein thrombosis is the most common thrombotic complication in patients with end-stage liver disease, and can have a negative impact on liver transplantation. The use of anticoagulant drugs has been proposed as a treatment for patients with portal vein thrombosis who are on the liver transplantation waiting list, with a composite goal of preventing thrombus progression and aiding the recanalization of the portal vein. Objectives: To assess the impact of portal vein thrombosis on the outcomes of liver transplantation, and to analyze the risks and benefits associated with the use of anticoagulant drugs in the preoperative period. Methods: The medical records of 425 patients who underwent liver transplantation in a tertiary Brazilian hospital were retrospectively reviewed. The patients were distributed in three groups: patients with no portal vein thrombosis (ST), patients with portal vein thrombosis who did not receive anticoagulation (TP) and patients with portal vein thrombosis who received anticoagulation (AC). The analysis included postoperative complications and long-term patient and graft survival in the three groups. Results: No significant adverse events were associated with the use of anticoagulant drugs. Patients in the TP group had a lower postoperative survival when compared with patients in the ST group (p=0,046). Patients with untreated portal vein thrombosis also showed an increased risk for postoperative portal vein thrombosis (TP:14,3%, ST:1,1%) and primary nonfunction of the liver graft (TP:6,3%, ST:1,7%). While patients in the AC group showed a trend towards higher survival when compared with patients in the TP group, the difference did not reach statistical significance (p=0,313). Conclusions: Patients with untreated portal vein thrombosis had poorer outcomes after undergoing liver transplantation, with a significantly lower postoperative survival. The pre-operative use of anticoagulant drugs is a safe strategy for the treatment of portal vein thrombosis, but further studies are necessary to accurately determine their impact on liver transplant outcomes. Keywords: Liver transplant; Hepatic cirrhosis; Thrombosis; Anticoagulants; Academic dissertation.