Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial

Authors

  • Wei Yao Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China https://orcid.org/0000-0001-6805-0993
  • Yongan Feng Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China https://orcid.org/0000-0001-9246-490X
  • Ting Liu Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China https://orcid.org/0000-0002-5646-2058
  • Wujun Li Department of General Surgery, the First Affiliated Hospital of Xi'an Medical University, 48 Fenghao West Road, Xi'an, Shaanxi, 710077, PR China https://orcid.org/0000-0002-7240-3234
  • Mei Zhang Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, Shaanxi 710061, P.R. China https://orcid.org/0000-0001-9209-7310
  • Yingmin Yao Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, Shaanxi 710061, P.R. China. E-mail: yaoyingmin@sina.com https://orcid.org/0000-0003-4302-5278
  • Shengli Wu Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, Shaanxi 710061, P.R. China. E-mail: victorywu2000@163.com https://orcid.org/0000-0001-9882-3504

DOI:

https://doi.org/10.17179/excli2020-3120

Keywords:

rivaroxaban, LMWH, warfarin, PVST , splenectomy

Abstract

This study aimed to evaluate the safety and efficacy of rivaroxaban in preventing portal vein system thrombosis (PVST) in patients with liver cirrhosis after splenectomy and pericardial devascularization. 70 cirrhotic patients undergoing splenectomy and pericardial devascularization were randomly assigned to rivaroxaban treatment (n=35) or low-molecular weight heparin (LMWH) plus warfarin treatment (n=35) for 30 days in this randomized controlled trial. The primary endpoint is the PVST formation. Ultrasound doctors and radiologists were blinded to the randomization results. Both groups received routine outpatient inspection every month and were followed for one year. 17 patients (48.6 %) in rivaroxaban group developed PVST, compared with 27 patients (77.1 %) in LMWH plus warfarin group (P=0.025). The incidence of PVST during the first year postoperation was significantly lower in rivaroxaban group than in LMWH plus warfarin group (F=7.901, P=0.006). The intra-group comparisons versus baseline showed the liver function improved from POD 21 to POM 1, and coagulation function improved from POM 2, in rivaroxaban group. In contrast, the liver function improved from POM 1 to POM 2, and coagulation function improved from POM 4, in LMWH plus warfarin group. The prophylactic use of rivaroxaban significantly decreases the incidence of PVST after splenectomy and pericardial devascularization in cirrhotic patients compared to LMWH plus warfarin treatment. Besides, rivaroxaban treatment was safe and effective and associated with better liver and coagulation functions improvement than LMWH plus warfarin treatment.

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Published

2021-03-04

How to Cite

Yao, W. ., Feng, Y. ., Liu, T., Li, W., Zhang, M., Yao, Y., & Wu, S. (2021). Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial. EXCLI Journal, 20, 537–549. https://doi.org/10.17179/excli2020-3120

Issue

Vol. 20 (2021)

Section

Original articles

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Copyright (c) 2021 Wei Yao, Yongan Feng, Ting Liu, Wujun Li, Mei Zhang, Yingmin Yao, Shengli Wu

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