Prognostic factors in splanchnic vein thromboses

Ageno W, et al. Long-term Clinical Outcomes of Splanchnic Vein Thrombosis: Results of an International Registry. JAMA Intern Med. 2015 Sep;175(9):1474-80. doi: 10.1001/jamainternmed.2015.3184.

Full-text for Emory users.

RESULTS: Of the 604 patients (median age, 54 years; 62.6% males), 21 (3.5%) did not complete follow-up. The most common risk factors for SVT were liver cirrhosis (167 of 600 patients [27.8%]) and solid cancer (136 of 600 [22.7%]); the most common sites of thrombosis were the portal vein (465 of 604 [77.0%]) and the mesenteric veins (266 of 604 [44.0%]). Anticoagulation was administered to 465 patients in the entire cohort (77.0%) with a mean duration of 13.9 months; 175 of the anticoagulant group (37.6%) received parenteral treatment only, and 290 patients (62.4%) were receiving vitamin K antagonists. The incidence rates (reported with 95% CIs) were 3.8 per 100 patient-years (2.7-5.2) for major bleeding, 7.3 per 100 patient-years (5.8-9.3) for thrombotic events, and 10.3 per 100 patient-years (8.5-12.5) for all-cause mortality. During anticoagulant treatment, these rates were 3.9 per 100 patient-years (2.6-6.0) for major bleeding and 5.6 per 100 patient-years (3.9-8.0) for thrombotic events. After treatment discontinuation, rates were 1.0 per 100 patient-years (0.3-4.2) and 10.5 per 100 patient-years (6.8-16.3), respectively. The highest rates of major bleeding and thrombotic events during the whole study period were observed in patients with cirrhosis (10.0 per 100 patient-years [6.6-15.1] and 11.3 per 100 patient-years [7.7-16.8], respectively); the lowest rates were in patients with SVT secondary to transient risk factors (0.5 per 100 patient-years [0.1-3.7] and 3.2 per 100 patient-years [1.4-7.0], respectively).

Thatipelli MR, et al. Survival and recurrence in  patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol. 2010 Feb;8(2): 200-5. doi: 10.1016/j.cgh.2009.09.019.

Full-text for Emory users.

RESULTS: The study (832 patients; mean age, 53 +/- 17 years; 42% women) included patients with isolated portal (n = 329), mesenteric (n = 76), splenic (n = 62), and hepatic (n = 45) vein thrombosis and patients with multisegment involvement (n = 320). Malignancy (27%) and cirrhosis (24%) were the most common etiologies. Recurrence-free survival 10 years after splanchnic vein thrombosis (76%) was comparable with that after DVT (68%) and not improved by anticoagulant therapy. Hormone therapy was the only independent predictor of recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09-4.45; P = .03). Major bleeding was 6.9/100 patient-years. Gastroesophageal varices (HR, 2.63; 95% CI, 1.72-4.03; P < .001) and warfarin therapy (HR, 1.91, 95% CI, 1.25-2.92; P = .003) were independent predictors of bleeding. The 10-year survival rate of patients with splanchnic vein thrombosis (60%) was lower than that of patients with DVT (68%, P < .05). Older age (HR, 1.03; 95% CI, 1.02-1.03), active cancer (HR, 2.23; 95% CI, 1.78-2.78), and myeloproliferative disorder (HR, 1.92; 95% CI, 1.41-2.61) were independent determinants of mortality (P < .001).

CONCLUSIONS: Splanchnic vein thrombosis depends on the pathology of the organ supplied. On the basis of the low rate of recurrence and substantial rate of major hemorrhage, prolonged anticoagulant therapy does not appear to be justified.

Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg. 2008 Oct;95(10):1245-51. doi: 10.1002/bjs.6319.

Full-text for Emory users.

RESULTS: Fifty-one patients had MVT, diagnosed at autopsy in six. The highest incidence (11.3 per 100,000 person-years) was in the age category 70-79 years. Activated protein C resistance was present in 13 of 29 patients tested. D-dimer at admission was raised in all five patients tested. Multidetector row computed tomography (CT) in the portal venous phase was diagnostic in all 20 patients investigated, of whom 19 were managed conservatively. The median length of resected bowel in 12 patients who had surgery was 0.6 (range 0.1-2.2) m. The overall 30-day mortality rate was 20 percent; intestinal infarction (P = 0.046), treatment on a non-surgical ward (P = 0.001) and CT not done (P = 0.022) were associated with increased mortality. Cancer was independently associated with long-term mortality: hazard ratio 4.03, 95 percent confidence interval 1.03 to 15.85; P = 0.046.

CONCLUSION: Portal venous phase CT appeared sensitive in diagnosing MVT. As activated protein C resistance was a strong risk factor, lifelong anti-coagulation should be considered.

More PubMed results on splanchnic vein thrombosis.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s