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J Gastrointest Surg. 2013 May;17(5):949-55. doi: 10.1007/s11605-013-2155-z. Epub 2013 Feb 6.

Perioperative strategies and thrombophilia in children with extrahepatic portal vein obstruction undergoing the meso-Rex bypass.

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  • 1Division of Hematology, Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, IL 60611, USA. rbhat@luriechildrens.org

Abstract

BACKGROUND/PURPOSE:

Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children.

OBJECTIVE:

The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass.

METHODS:

Records of children who underwent meso-Rex bypass for EHPVO at a single institution from 1999 to 2009 were reviewed, and preoperative thrombophilia testing, perioperative anticoagulation strategies, and postoperative bypass patency based on imaging at last follow-up were examined.

RESULTS:

Sixty-five children with EHPVO underwent a first time meso-Rex bypass during the study period, and 9 of 65 (14 %) developed bypass thrombosis. The use of warfarin in the postoperative period was more common among children with thrombosed shunts than among those with open shunts [63 % vs. 20 %; OR, 6.5 (95 % CI, 1.3-31.5), p = 0.022]. The contribution of genetic or acquired thrombophilia to shunt thrombosis was inconclusive given variability in testing.

CONCLUSIONS:

Choice of anticoagulation following meso-Rex bypass may affect postoperative incidence of bypass thrombosis. Role of thrombophilic risk factors in the development of shunt thrombosis remains unclear.

PMID:
23385441
[PubMed - indexed for MEDLINE]
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