Highlights
- •Current guidelines recommend to anticoagulate SVT only if symptomatic.
- •We assessed the rate and severity of VTE recurrences and major bleeding during therapy.
- •During anticoagulation, the severity of bleeding may outweigh the severity of recurrences.
- •Further studies should identify what SVT patients may benefit from anticoagulation.
Abstract
Introduction
Current guidelines recommend the use of anticoagulant therapy in patients with symptomatic
splanchnic vein thrombosis (SVT) and suggest no routine anticoagulation in those with
incidental SVT.
Methods
We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to
assess the rate and severity of symptomatic venous thromboembolism (VTE) recurrences
and major bleeding events appearing during the course of anticoagulation in patients
with symptomatic or incidental SVT.
Results
In March 2017, 521 patients with SVT were recruited. Of them, 212 (41%) presented
with symptomatic SVT and 309 had incidental SVT. Most (93%) patients received anticoagulant
therapy (median, 147 days). During the course of anticoagulation, 20 patients developed
symptomatic VTE recurrences (none died) and 26 had major bleeding (fatal bleeding,
5). On multivariable analysis, patients with incidental SVT had a non-significantly
higher risk for symptomatic VTE recurrences (adjusted hazard ratio [HR]: 2.04; 95%CI:
0.71–5.88) and a similar risk for major bleeding (HR: 1.12; 95%CI: 0.47–2.63) than
those with symptomatic SVT. Active cancer was associated with at increased risk for
VTE recurrences (HR: 3.06; 95%CI: 1.14–8.17) and anaemia (HR: 4.11; 95%CI: 1.45–11.6)
or abnormal prothrombin time (HR: 4.10; 95%CI: 1.68–10.1) were associated with at
increased risk for major bleeding.
Conclusions
The rates of recurrent SVT and major bleeding were similar between patients with incidental
or symptomatic SVT. Because the severity of bleeding complications during anticoagulation
may outweigh the severity of VTE recurrences in both groups, further studies should
identify those SVT patients who benefit from anticoagulant therapy.
Abbreviations:
SVT (splanchnic vein thrombosis), VTE (venous thromboembolism), DVT (deep vein thrombosis), PE (pulmonary embolism)Keywords
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Article info
Publication history
Published online: February 22, 2018
Accepted:
February 21,
2018
Received in revised form:
January 17,
2018
Received:
November 15,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
