摘要
门静脉血栓（PVT）是肝硬化患者常见的严重并发症，发生率可达10%-25%，其形成会加剧门静脉高压症进展并加速肝功能失代偿。抗凝治疗在促进血栓溶解和预防复发方面已被证实具有明确疗效，但临床实施需严格权衡出血风险。低分子肝素（LMWH）凭借其稳定的药代动力学特性成为基础抗凝方案，但其剂量方案需依据Child-Pugh分级进行个体化调整；而直接口服抗凝药物（DOACs）的疗效和安全性仍需更多循证医学证据支持。临床决策应整合HAS-BLED评分系统评估出血风险，结合CHA2DS2-VASc评分预测血栓栓塞事件，并通过国际标准化比值（INR）及抗Xa因子活性检测实现治疗方案的动态调整。最新研究进展提示，基于基因多态性分析的个体化给药策略及人工智能辅助决策系统，可能为PVT的精准治疗提供新的研究方向。
关键词： 肝硬化门静脉血栓形成；抗凝治疗；风险获益评估；个体化治疗；肝功能监测
Abstract
Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis, with an incidence of 10%-25%. Its formation will aggravate the progression of portal hypertension and accelerate liver decompensation. Anticoagulant therapy has been proven to have a clear effect in promoting thrombolysis and preventing recurrence, but clinical implementation requires strict consideration of bleeding risks. Low molecular weight heparin (LMWH) has become the basic anticoagulant regimen due to its stable pharmacokinetic properties, but its dosage regimen needs to be adjusted individually according to the Child-Pugh classification; while the efficacy and safety of direct oral anticoagulants (DOACs) still need more evidence-based medical support. Clinical decision-making should integrate the HAS-BLED scoring system to assess bleeding risk, combine the CHA2DS2-VASc score to predict thromboembolic events, and dynamically adjust the treatment regimen through the international normalized ratio (INR) and anti-Xa factor activity detection. The latest research progress suggests that individualized drug administration strategies based on gene polymorphism analysis and artificial intelligence-assisted decision-making systems may provide new research directions for the precise treatment of PVT.
Key words： Cirrhotic portal vein thrombosis; Anticoagulant therapy; Risk-benefit assessment; Individualized treatment; Liver function monitoring
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