Recurrent Thrombotic Events after Discontinuation of Vitamin K Antagonist Treatment for Splanchnic Vein Thrombosis: A Multicenter Retrospective Cohort Study

Nicoletta Riva,Walter Ageno,Monica Carpenedo,Giuliana Martini,Alberto Tosetto,Rita Santoro,Paolo Gresele,Sophie Testa,Teresa Lerede,Piera Maria Ferrini,Antonietta Piana,Daniela Poli,Serena Rupoli,Carlo Bonfanti,Alberto Nicolini,Catello Mangione,Laura Contino

doi:10.1155/2015/620217

Abstract

It is generally recommended that patients with splanchnic vein thrombosis (SVT) should receive a minimum of 3 months of anticoagulant treatment. However, little information is available on the long-term risk of recurrent thrombotic events. The aim of this study was to evaluate the risk of venous and arterial thrombosis after discontinuation of vitamin K antagonist (VKA) in SVT patients. Retrospective information from a cohort of SVT patients treated with VKA and followed by 37 Italian Anticoagulation Clinics, up to June 2013, was collected. Only patients who discontinued VKA and did not receive any other anticoagulant drug were enrolled in this study. Thrombotic events during follow-up were centrally adjudicated. Ninety patients were included: 33 unprovoked SVT, 27 SVT secondary to transient risk factors, and 30 with permanent risk factors. During a median follow-up of 1.6 years, 6 venous and 1 arterial thrombosis were documented, for an incidence of 3.3/100 patient-years (pt-y). The recurrence rate was highest in the first year after VKA discontinuation (8.2/100'pt-y) and in patients with permanent risk factors (10.2/100'pt-y). Liver cirrhosis significantly increased the risk of recurrence. In conclusion, the rate of recurrent vascular complications after SVT is not negligible, at least in some patient subgroups.

Highlights

Splanchnic vein thrombosis (SVT) involves one or more abdominal veins [1] and carries a substantial risk of bowel ischemia and chronic portal hypertension
112 (29.9%) of 375 splanchnic vein thrombosis (SVT) patients treated with vitamin K antagonist (VKA) discontinued the oral anticoagulant treatment
Personal history of venous thromboembolism (VTE) was reported in 7.8%, while family history of VTE was reported in 8.9%

Summary

Introduction

Splanchnic vein thrombosis (SVT) involves one or more abdominal veins (portal, mesenteric, splenic, and suprahepatic veins) [1] and carries a substantial risk of bowel ischemia and chronic portal hypertension. Myocardial infarction and ischemic stroke are common in SVT patients and the cumulative incidence of arterial and venous thrombotic events after SVT has been estimated to be 5.5 per 100 patient-years [4]. These data included both on-treatment patients and off-treatment patients. In the presence of a persistent risk factor (e.g., myeloproliferative neoplasms) or unprovoked SVT, or in patients with severe thrombosis (e.g., BuddChiari syndrome), extended anticoagulation is suggested, with periodic reassessment of the bleeding risk [6, 7]

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