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Semin Thromb Hemost 2014; 40(01): 099-105
DOI: 10.1055/s-0033-1363473
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antithrombotic Treatment of Splanchnic Vein Thrombosis: Results of an International Registry

Walter Ageno
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
,
Nicoletta Riva
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
,
Sam Schulman
2   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Soo Mee Bang
3   Department of Internal Medicine, Seoul National University, Seoul, South Korea
,
Maria Teresa Sartori
4   Clinical Medicine II, University Hospital of Padova, Padova, Italy
,
Elvira Grandone
5   IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
,
Jan Beyer-Westendorf
6   Division of Angiology, Center for Vascular Medicine and Department of Medicine III, University Hospital “Carl Gustav Carus”, Dresden, Germany
,
Giovanni Barillari
7   Center for Hemorrhagic and Thrombotic Diseases, University Hospital, Udine, Italy
,
Matteo Nicola Dario Di Minno
8   Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
,
Francesco Dentali
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
,
on behalf of the IRSVT study group › Author Affiliations
Further Information

Publication History

Publication Date:
31 December 2013 (online)

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Abstract

Treatment of splanchnic vein thrombosis (SVT) is a clinical challenge due to heterogeneity of clinical presentations, increased bleeding risk, and lack of evidences from clinical trials. We performed an international registry to describe current treatment strategies and factors associated with therapeutic decisions in a large prospective cohort of unselected SVT patients. A total of 613 patients were enrolled (mean age 53.1 years, standard deviation ± 14.8); 62.6% males; the majority (468 patients) had portal vein thrombosis. Most common risk factors included cirrhosis (27.8%), solid cancer (22.3%), and intra-abdominal inflammation/infection (11.7%); in 27.4% of patients, SVT was idiopathic. During the acute phase, 470 (76.7%) patients received anticoagulant drugs, 136 patients (22.2%) remained untreated. Incidental diagnosis, single vein thrombosis, gastrointestinal bleeding, thrombocytopenia, cancer, and cirrhosis were significantly associated with no anticoagulant treatment. Decision to start patients on vitamin K antagonists after an initial course of parenteral anticoagulation was significantly associated with younger age, symptomatic onset, multiple veins involvement, and unprovoked thrombosis. Although a nonnegligible proportion of SVT patients did not receive anticoagulant treatment, the majority received the same therapies recommended for patients with usual sites thrombosis, with some differences driven by the site of thrombosis and the pathogenesis of the disease.

Keywords

splanchnic vein thrombosis - heparin - vitamin K antagonist
 

  • References

  • 1 Rajani R, Melin T, Björnsson E , et al. Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival - an 18-year experience. Liver Int 2009; 29 (2) 253-259
    CrossrefPubMedGoogle Scholar
  • 2 Rajani R, Björnsson E, Bergquist A , et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther 2010; 32 (9) 1154-1162
    CrossrefPubMedGoogle Scholar
  • 3 Ageno W, Squizzato A, Togna A , et al. Incidental diagnosis of deep vein thrombosis in consecutive patients undergoing a computed tomography scan of the abdomen: a retrospective cohort study. J Thromb Haemost 2012; 10 (1) 158-160
    CrossrefPubMedGoogle Scholar
  • 4 Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol 2010; 8 (2) 200-205
    CrossrefPubMedGoogle Scholar
  • 5 Dentali F, Squizzato A, Brivio L , et al. JAK2V617F mutation for the early diagnosis of Ph- myeloproliferative neoplasms in patients with venous thromboembolism: a meta-analysis. Blood 2009; 113 (22) 5617-5623
    CrossrefPubMedGoogle Scholar
  • 6 Van Bijnen ST, Van Heerde WL, Muus P. Mechanisms and clinical implications of thrombosis in paroxysmal nocturnal hemoglobinuria. J Thromb Haemost 2012; 10 (1) 1-10
    CrossrefPubMedGoogle Scholar
  • 7 Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95 (10) 1245-1251
    CrossrefPubMedGoogle Scholar
  • 8 Kearon C, Akl EA, Comerota AJ , et al; American College of Chest Physicians. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2 Suppl): e419S-e494S
    CrossrefPubMedGoogle Scholar
  • 9 Plessier A, Darwish-Murad S, Hernandez-Guerra M , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (1) 210-218
    CrossrefPubMedGoogle Scholar
  • 10 Condat B, Pessione F, Hillaire S , et al. Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 2001; 120 (2) 490-497
    CrossrefPubMedGoogle Scholar
  • 11 Darwish Murad S, Plessier A, Hernandez-Guerra M , et al; EN-Vie (European Network for Vascular Disorders of the Liver). Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med 2009; 151 (3) 167-175
    CrossrefPubMedGoogle Scholar
  • 12 Lee AY, Levine MN, Baker RI , et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (2) 146-153
    CrossrefPubMedGoogle Scholar