Anticoagulation and antiplatelets as prophylaxis for hepatic artery thrombosis after liver transplantation  

作　　者：Abdullah A Algarni Moustafa M Mourad Simon R Bramhall 

机构地区：[1]Liver Unit, Queen Elizabeth Hospital,Birmingham B15 2TH, United Kingdom [2]General Surgery Department, Wye Valley NHS Trust

出　　处：《World Journal of Hepatology》2015年第9期1238-1243,共6页世界肝病学杂志（英文版）（电子版）

摘　　要：Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.Hepatic artery thrombosis （HAT） is the most seriousvascular complication after liver transplantation.Multiple risk factors have been identified to impactits development. Changes in haemostasis associatedwith end stage liver disease and the disturbance ofthe coagulation and anticoagulation cascades play an important role in development of this lethal complication.Early recognition and therapeutic intervention ismandatory to avoid its consequences. Pharmacologicalprophylaxis, by the use of antiplatelet or anticoagulantagents, is an important tool to reduce its incidenceand prevent graft loss. Only a few studies have showna clear benefit of antiplatelet agents in reducing HAToccurrence, however, these studies are limited by beingretrospective and by inhomogeneous populations. Theuse of anticoagulants such as heparin is associated withan improvement in the outcomes mainly when used fora high-risk patients like living related liver recipients.The major concern when using these agents is thetendency to increase bleeding complications in a settingof already unstable haemostasis. Hence, monitoring oftheir administration and careful selection of patientsto be treated are of great importance. Well-designedclinical studies are still needed to further explore theireffects and to formulate proper protocols that can beimplemented safely.

关 键 词：Hepatic artery THROMBOSIS HAEMOSTASIS ANTICOAGULATION Liver transplantation ANTIPLATELETS HEPARIN 

分 类 号：R657.3[医药卫生—外科学]