RESUMO
Transjugular intrahepatic portosystemic shunt (TIPS), after nearly 30 years of continuous exploration and development, has been widely used in the treatment of complications of portal hypertension. TIPS has significant advantages in acute esophagogastric variceal bleeding, prevention of rebleeding, refractory peritoneal effusion, and Budd-Chiari syndrome; however, if postoperative anticoagulant measures are inappropriate, it can cause several complications, such as stent dysfunction and acute thrombosis, and lead to the recurrence of the symptoms of portal hypertension before TIPS, which greatly affects middle- and long-term clinical outcomes and survival rate. Maintenance of stent patency is the key to good postoperative treatment outcome, and therefore, anticoagulants play an important role in the prevention and treatment of post-TIPS thrombosis. At present, no consensus has been reached on post-TIPS anticoagulant therapy in China and foreign countries. This article reviews the research advances in the application of anticoagulants after TIPS.
RESUMO
Esophagogastric variceal bleeding is one of the most common complications of liver cirrhosis and is also one of the most critical diseases in the department of gastroenterology, with the features of acute onset and high rebleeding and mortality rates. Strengthening the understanding of related prognostic factors has great clinical significance in reducing early rebleeding rate and mortality rate. There are many factors associated with rebleeding and death in patients with esophagogastric variceal bleeding. Risk factors include advanced age, sex, Child-Turcotte-Pugh class C, low platelet count, high leukocyte count, bleeding history, portal broadening, widening of the portal vein, a positive red-color sign under an endoscope, severe varices, and infection, while the percentage of lymphocytes, serum sodium, and the use of non-selective β-blockers and antibiotics are protective factors. By analyzing these prognostic factors, we can learn more about their mechanisms and risk degree. At present, related research mainly focuses on the exploration of better individual treatment regimens and nursing strategies based on the risk assessment models established using these risk factors to reduce the risk of rebleeding and death.
RESUMO
Objective To explore the risk factors affected the timing of endoscopic examination in nonvariceal upper gastrointestinal bleeding (NVUGIB).Methods From January 2001 to December 2011 , 441 patients diagnosed as NVUGIB under endoscope were enrolled,and they were divided into the group receiving endoscopy within 24 hours (233 cases)and the group receiving endoscopy beyond 24 hours (208 cases).The demographic and clinical characteristics of the two groups were analyzed.Student′s t test was used for measurement data comparison and chi-square test for numerical data.Logistic regression analysis was used to analyze the multivariate factors which influenced the timing of endoscopy examination.Results The rates of complication in the group receiving endoscopy within 24 hours and the group receiving endoscopy beyond 24 hours were 9.0% (21/233)and 19.7% (41/208),and the difference was statistically significant (χ2 =10.411 ,P =0.001 ).The mean systolic blood pressure were (118 ±19 )and (122±19)mmHg (1 mmHg=0.133 kPa),respectively,and the difference was statistically significant (t=2.099,P = 0.036 ).On admission the mean hemoglobin were (98 ± 27 )and (93 ± 28 )g/L, respectively,and the difference was not statistically significant (t=1 .640,P =0.102).The mortality rate were 1 .3% (3/233 )and 5 .3% (11/208 ),respectively,and the difference was statistically significant (χ2 =5 .723,P =0.017).With multivariate Logistic regression,multivariate factors analysis indicated that complication was the main factor influenced the timing of endoscopy examination (OR =2.710,95 %CI :1 .502 to 4.899,P 0.05).Conclusion Complication is a risk factor in the timing delayed endoscopy.