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Managing Splanchnic Vein Thrombosis
Management of splanchnic vein thrombosis (SVT), which includes portal, mesenteric, splenic, and hepatic vein thrombosis, is heterogenous, given a lack of randomized clinical trials (RCTs). To evaluate the efficacy and safety of anticoagulation in patients with SVT, investigators performed a meta-analysis of individual patient data. Measures of efficacy included recurrent venous thrombosis and all-cause mortality; measures of safety included major bleeding.
A total of 1635 patients from three studies (no RCTs) were analyzed. The most common causes for SVT included solid tumors (32.0%), cirrhosis (17.6%), and myeloproliferative neoplasms (7.2%). SVT was unprovoked in 28.3% of cases. Eighty percent of patients were treated with anticoagulation, most commonly low-molecular-weight heparin (LMWH) alone (31.9%) and vitamin K antagonist alone (25.4%). Direct oral anticoagulants (DOAC) were used less frequently (1.7%), and 19.8% of patients were untreated.
The incidence rates for recurrent venous thromboembolism (VTE), major bleeding, and mortality were 5.3, 4.4, and 13.0 per 100 patient-years, respectively. In the multivariable analysis, anticoagulant therapy reduced risks for recurrent VTE (hazard ratio, 0.42), major bleeding (HR, 0.47), and all-cause mortality (HR, 0.23).
This meta-analysis supports use of anticoagulation for the management of SVT —risks for both recurrent VTE and bleeding were reduced. The latter may have been due to reduction in portal pressures. The optimal dose, duration, and type of anticoagulant is unclear, however. DOAC use was rare in this analysis, potentially due to patient variables such as malignancy and cirrhosis, where LMWH may still be more commonly used. Multidisciplinary management is critical for patients with SVT, and these data should be encouraging for hematologists and hepatologists alike.
Candeloro M et al.
Title: Anticoagulant therapy for splanchnic vein thrombosis: An individual patient data meta-analysis.
Source: Blood Adv 2022 Aug 9; [e-pub]. (Abstract/FREE Full Text)