Splanchnic vein thrombosis: aetiology, therapy, and results – a retrospective analysis
Authors:
T. Kriegler 1,2; P. Ďulíček 3; T. Dušek 2,4
Authors‘ workplace:
Chirurgické oddělení, Chrudimská nemocnice, Nemocnice Pardubického kraje
1; Katedra vojenské chirurgie, Vojenská lékařská fakulta Hradec Králové, Univerzita obrany v Brně
2; IV. interní hematologická klinika LF UK a FN Hradec Králové
3; Chirurgická klinika LF UK a FN Hradec Králové
4
Published in:
Transfuze Hematol. dnes,30, 2024, No. 2, p. 113-117.
Category:
Original Papers
doi:
https://doi.org/10.48095/cctahd2024prolekare.cz9
Overview
SUMMARY: Splanchnic vein thrombosis is a thrombosis at a so-called unusual site. It includes portal vein thrombosis, mesenteric vein thrombosis, thrombosis of the splenic vein and Budd-Chiari syndrome. Aetiology of thrombosis is usually multifactorial; causes can be systemic or local. However, aetiology sometimes remains unclear. Thrombosis may also occur following abdominal surgery. The management of these patients is not unified, because of the low incidence and absence of specific guidelines. We retrospectively analysed a cohort of 40 patients from two regions of our republic (15 males, 25 females, mean age 38 years) focusing on aetiology, therapy and further management. Aetiology was identified in 21 patients with a predominance of JAK2 V617F mutation. In all cases, thrombosis was objectively detected by Doppler ultrasound or angio-CT. Anticoagulation therapy with low molecular weight heparin (LMWH) was the treatment of choice in all cases, switching to warfarin or direct oral anticoagulants (DOAC). The prognosis of splanchnic vein thrombosis depends on the severity and localisation, aetiology and timely treatment.
Keywords:
anticoagulation therapy – aetiology – splanchnic vein thrombosis – prothrombotic state
Sources
1. Myers K, Hannah P. Anatomy of veins and lymphatics In: Myers K, Hannah P, editors. Manual of Venous and Lymphatic Diseases. London, UK: Taylor & Francis Ltd; 2018: 13–38. doi: 10.2147/VHRM.S197732
2. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016; 118 (9): 1340–1347. doi: 10.1161/ CIRCRESAHA.115.306841.
3. Ageno W, Squizzato A, Togna A, et al. Incidental diagnosis of a 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. doi: 10.1111/j.1538-7836.2011.04565.x.
4. 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. doi: 10.1111/j.1365-2036.2010.04454.x.
5. Li Y, De Stefano V, Li H, et al. Epidemiology of Budd-Chiari syndrome: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2018. pii: S2210-7401 (18) 30230-4. doi: 10.1016/j.clinre.2018.10.014.
6. Ageno W, Dentali F, Pomero F, et al. Incidence rates and case fatality rates of portal vein thrombosis and Budd-Chiari syndrome. Thromb Haemost. 2017; 117 (4): 794–800. doi: 10.1160/TH16-10-0781.
7. Ageno W, Dentali F, Squizzato A. How I treat splanchnic thrombosis. Blood. 2014; 124 (25): 3685–3691. doi: 10.1182/blood-2014-07-551 515.
8. Thatipelli MR, McBane RD, Hodge DO, et al. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol. 2010; 8 (2): 200–205. doi: 10.1016/ j.cgh.2009.09.019.
9. Ageno W, Riva N, Schulman S, et al. Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry. JAMA Intern Med. 2015; 175 (9): 1474–1480. doi: 10.1001/jamainternmed.2015.3184.
10. Lajzová S, Kroupa R, Bulíková A, et al. Splanchnická žilní trombóza. Vnitř Lék. 2018; 64 (3): 272–279. doi: 10.36290/vnl.2018.038.
11. Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol. 2006; 3 (9): 505–515. doi: 10.1038/ncpgasthep0577.
12. European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016; 64 (1): 179–202. doi: 10.1016/j.jhep.2015.07. 040.
13. de Franchis R, Faculty BV. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015; 63 (3): 743–752. doi: 10.1016/ j.jhep.2015.05.022.
14. Kearon C, Akl EA, Comerota AJ, et al. 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–e496S. doi: 10.1378/chest.11-2301.
15. Turnes J, García-Pagán JC, González M, et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol. 2008; 6 (12): 1412–1417. doi: 10.1016/ j.cgh.2008.07.031.
16. Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012; 10 (7): 776–783. doi: 10.1016/j.cgh.2012.01.012.
17. Joh JH, Kim DI. Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg. 2005; 29 (2): 204–208. doi: 10.1016/ j.ejvs.2004.10.005.
18. Zhang B, Kim M, Griffiths Ch, et al. Incidence of splanchnic vein thrombosis after abdominal surgery: a systematic review and meta-analysis J Surg Res. 2020; 245: 500–509. doi: 10.1016/ j.jss.2019.07.086.
19. Riva N, Ageno W, Poli D, et al. Safety of vitamin K antagonist treatment for splanchnic vein thrombosis: a multicenter cohort study. J Thromb Haemost. 2015; 13 (6) 1019–1027. doi: 10.1111/jth.12930.
20. Spaander MC, Hoekstra J, Hansen BE, et al. Anticoagulant therapy in patients with non-cirrhotic portal vein thrombosis: effect on new thrombotic events and gastrointestinal bleeding. J Thromb Haemost. 2013; 11 (3): 452–459. doi: 10.1111/jth.12121.
21. Mimier MK, Janczak DT, McBane RD, Houghton DE, Wysokinski WE. Thrombosis of atypical location: how to treat patients in the era of direct oral anticoagulants? Pol Arch Intern Med. 2018; 128 (10): 604–608. doi: 10.20452/ pamw.4333.
22. De Gottardi A, Trebicka J, Klinger C, et al. Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis. Liver Int. 2017; 37 (5): 694–699. doi: 10.1111/liv.13 285.
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