Prognostic Factors in Noncirrhotic Patients With Splanchnic Vein Thromboses

TLDR

Splanchnic vein thrombosis (SVT) in patients without cancer or cirrhosis is rare and little is known about its natural history, long‑term prognosis, or optimal treatment. The authors prospectively followed 121 consecutive SVT patients (95 with a median 41‑month follow‑up) from 1998‑2005, performed thrombophilia screening in 104, and recorded new thrombotic or bleeding events while administering anticoagulation per predefined criteria. Survival was 95 %, 93.3 %, and 89.6 % at 1, 3, and 7 years, respectively, with most deaths occurring at SVT onset; superior mesenteric vein thrombosis was associated with higher symptom and infarction rates, 14.7 % experienced gastrointestinal bleeding, 10.5 % had new venous events (mostly splanchnic), and anticoagulation achieved recanalization in 45.4 % and prevented recurrence when continued lifelong.

Abstract

Splanchnic vein thrombosis (SVT), not associated with cancer or liver cirrhosis, is a rare event and scanty data are available on its natural history, long-term prognosis, and treatment. In this study 121 SVT patients consecutively seen from January 1998 to December 2005 were included and 95 of them were followed up for a median time of 41 months. Screening for thrombophilic factors was performed in 104 patients. New thrombotic or bleeding episodes were registered and anticoagulant therapy was performed according to preestablished criteria.SVT was an incidental finding in 34 (28.1%) patients; 34 (28.1%) presented with abdominal infarction; 39 (32.2%) had bowel ischemia or acute portal vein thrombosis; 14 (11.6%) had bleeding from portal hypertensive sources. Survival rates at 1, 3, and 7 yr were 95%, 93.3%, and 89.6%, respectively; 87.5% of deaths occurred at onset of SVT as complications of intestinal infarction. Patients with isolated portal vein thromboses had symptoms and intestinal infarction in 16/41 (39%) and 0/41 (0%) of the cases, respectively, whereas superior mesenteric vein thromboses, isolated or not, were associated with symptoms and intestinal infarction in 69/75 (92%) and 34/75 (45%), respectively. During the follow-up 14 (14.7%) suffered from 39 episodes of gastrointestinal bleeding with no deaths. A previous gastrointestinal bleed was associated with new hemorrhagic events during follow-up. New venous thrombotic episodes occurred in 10 of 95 patients (10.5%), of which 73% were in the splanchnic area. Seven out of these 10 patients had a chronic myeloproliferative disease (MPD) and none was on anticoagulation.Anticoagulant therapy was effective to obtain recanalization of acute SVT in 45.4% of patients and preserved patients from recurrent thrombosis when given lifelong.