Factors associated with therapeutic strategies in patients with splanchnic vein thrombosis: Results of an international registry

N. Riva, W. Ageno, S. Schulman, S.M. Bang, M.T. Sartori, E. Grandone, J. Beyer, G. Barillari, D. Di Minno, R. Duce, A. Malato, R. Santoro, D. Poli, P. Verhamme, I. Martinelli, P. Kamphuisen, A. Alatri, C. Becattini, E. Bucherini, A. PianaV. De Stefano, F. Dentali

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Abstract

Background Treatment of splanchnic vein thrombosis (SVT) is challenging due to the heterogeneous clinical presentation and the increased bleeding risk. We aimed to describe current treatment strategies and factors associated with therapeutic decisions. Materials and Methods Between May 2008 and January 2012, consecutive SVT patients were included in an international registry collecting information on etiology, diagnostic process and therapeutic management. Results During the acute phase, 474 (77.5%) of the 613 included patients were treated with anticoagulant drugs: unfractionated heparin (10.4%), low molecular weight heparin or fondaparinux (67.2%), vitamin K antagonists (VKA) (48.9%). Four patients received aspirin. Surgery and thrombolysis were performed in 3.1% and 1.5% whereas 130 patients (21.2%) were untreated. Of patients with incidentally diagnosed SVT, 63.3% received anticoagulant treatment. The decision not to treat patients was significantly associated with incidental diagnosis, single vein thrombosis, gastrointestinal bleeding, thrombocytopenia, cancer and cirrhosis. Treated patients had significantly more history of venous thrombosis, myeloproliferative neoplasm, surgery and hormonal treatment. Within one month from diagnosis, 300 patients were started on VKA. These patients were significantly younger and had more symptomatic onset, multiple vein involvement and unprovoked thrombosis than patients not started on VKA. Conversely, 174 patients were maintained on parenteral anticoagulation, especially if anemia, thrombocytopenia, cancer and cirrhosis were present. Currently, information on clinical events during the first month is available for 551 patients, showing 5 thrombosis extensions (2 treated and 3 untreated patients), 4 major bleeding (2 in each group) and 11 deaths (7 and 4, respectively). Conclusions Despite the increased bleeding risk and recent guidelines suggesting not to treat incidentally detected SVTs, 77.5% of newly diagnosed SVTs receive anticoagulant therapy in clinical practice. Longstanding parenteral drugs are often used in patients at perceived higher bleeding risk. The longterm follow up will provide additional data on thrombotic and hemorrhagic complications.
Original languageEnglish
Pages (from-to)123
Number of pages1
JournalBlood transfusion
Volume10
Publication statusPublished - 1-Sep-2012

Keywords

  • heparin
  • acetylsalicylic acid
  • anticoagulant agent
  • antivitamin K
  • fondaparinux
  • low molecular weight heparin
  • human
  • vein thrombosis
  • register
  • society
  • thrombosis
  • hemostasis
  • patient
  • bleeding
  • risk
  • diagnosis
  • anticoagulant therapy
  • liver cirrhosis
  • neoplasm
  • thrombocytopenia
  • surgery
  • gastrointestinal hemorrhage
  • blood clot lysis
  • follow up
  • clinical practice
  • anticoagulation
  • vein
  • myeloproliferative neoplasm
  • anemia
  • death
  • etiology

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