Unusual site thrombosis: splanchnic vein thrombosis, management in noncirrothic

Abstract

Objective: Determine clinical characteristics, bleedings, thrombotic events and mortality in splanchnic venous thrombosis (SVT) in non-cirrhotic patients. Material and methods: Retrospective cohort (2008-2015) of non-cirrhotic (single center). We evaluated: risk factors; symptoms, location, chronicity, and anticoagulant treatment. During the follow up: evaluated all-causes mortality, thrombotic and bleedings events. Results: 70 patients. Most frequent risk factors: Infectious-inflammatory abdominal conditions (54%) and solid cancer (40%). Affected veins: portal, splenic, mesenteric or multiple. Of all, 54 patients received anticoagulant treatment (average 6.7 months). They were treated with low molecular weight heparin (LMWH) (85%) or vitamin K antagonist (VKA) (15%). Median follow-up was 12 months. Complications: 21 patients (30%) had thrombosis and 18 (26%) major bleeding. The incidence rates were 8.6 per 100 patient-years for major bleeding, 13.9 per 100 patient-years for thrombotic events and 11.9 per 100 patient-years for all-cause mortality. Major bleeding rates were 7.1 per 100 patient-years and 9.6 per 100 patient-years with or without anticoagulant treatment, respectively. Thrombotic events rates were 14.1 per 100 patient-years and 13.9 per 100 patient-years with or without anticoagulant treatment, respectively. Highest rates of major bleeding and thrombotic events were in solid cancer (15.7 per 100 patient-years and 31.4 per 100 patient-years, respectively). Conclusions: SVT has high baseline bleeding risk, although thrombotic events are also high. It9s important balance risk benefit of anticoagulant therapy.