To evaluate the efficacy of rivaroxaban in the treatment of portal vein thrombosis (PVT) after splenectomy combined with pericardial devascularization.

Clinical data of 37 patients with liver cirrhosis complicated with PVT who underwent splenectomy combined with pericardial devascularization in Fifth Medical Center of PLA General Hospital from June 1, 2019 to June 1, 2022 were retrospectively analyzed. Among them, 10 patients were male and 27 female, aged (52±4) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 27 patients were diagnosed with hepatitis B virus cirrhosis, 8 cases of autoimmune cirrhosis and 2 cases of alcoholic cirrhosis. 12 cases were diagnosed with PVT complicated with gastrointestinal bleeding and 25 cases of upper gastrointestinal bleeding alone before surgery. 37 patients were treated with low-molecular-weight heparin at postoperative 1 to 3 d, and then changed to oral intake of rivaroxaban. The dosage of rivaroxaban was adjusted according to drug reactions and prothrombin activation. At postoperative 3-5 d, routine color Doppler ultrasound or enhanced CT scan of upper abdomen were performed to assess the changes of PVT. At postoperative 1 month, enhanced CT scan was performed to evaluate clinical efficacy.

At postoperative 1 week, the incidence of de novo PVT was 38%(14/37), including8 cases of grade Ⅰ, 3 cases of grade Ⅱ, 2 cases of grade Ⅲ and 1 case of grade Ⅳ. The incidence of de novo PVT in patients with old PVT before surgery was approximately 58% (7/12), including 3 cases of complete thrombolysis of de novo PVT, 3 cases of partial thrombolysis of de novo PVT, and 1 case of cavernous transformation of the portal vein who suffered grade Ⅳ PVT postoperatively. Thrombolysis combined with embolectomy through internal jugular vein yielded no efficacy, and oral intake of rivaroxaban was given. For patients with old PVT before surgery, PVT could not be treated, considering the possibility of thrombosis organization. The incidence of PVT in patients with upper gastrointestinal bleeding alone was 28% (7/25), including 4 cases of complete thrombolysis of de novo PVT and 3 cases of partial thrombolysis of de novo PVT. 6 patients developed gingival and subcutaneous bleeding after oral intake of rivaroxaban, which was alleviated after reducing the dosage of rivaroxaban. All patients were given with oral intake of rivaroxaban for 6 months after PVT thrombolysis.

Rivaroxaban after splenectomy combined with pericardial devascularization is safe and efficacious protocol in preventing de novo PVT, which can bring benefits to patients after splenectomy combined with pericardial devascularization.