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Anticoagulant Therapy for Splanchnic Vein Thrombosis: A Systematic Review and Meta-Analysis

1G. d'Annunzio University, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy, 2G. d'Annunzio University, Department of Medicine and Ageing Sciences, Chieti, Italy, 3University of Malta, Department of Pathology, Faculty of Medicine and Surgery, Msida, Malta, 4Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, National Hemophilia Center, Tel Hashomer, Israel, 5Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel, 6University of Barcelona, Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, Barcelona, Spain, 7University of Insubria, Department of Medicine and Surgery, Varese, Italy

Abstract Number: PB2254

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Visceral Vein Thrombosis

Background: Treatment of splanchnic vein thrombosis (SVT) remains controversial.

Aims: In this systematic review and meta-analysis, we evaluated the efficacy and safety of anticoagulant therapy in patients with SVT that was unprovoked or associated with transient or persistent risk factors.

Methods: MEDLINE, EMBASE, and clinicaltrial.gov were searched up to December 2019. Studies reporting the rate of SVT recanalization or progression, recurrent VTE, major bleeding, and overall mortality were included. Pooled proportion and risk ratio (RR) with corresponding 95% confidence intervals (CI) were calculated using a random-effects model.

Results: A total of 7,969 patients were included in 98 studies (95 observational studies and 3 randomized controlled trials). During anticoagulation, 58% (95% CI, 51-64) of patients achieved partial or complete recanalization, while 5% (95% CI, 3-7) experienced SVT progression. Recurrent VTE, major bleeding, and overall mortality occurred in 12% (95% CI, 9-16), 9% (95% CI, 7-12), and 11% (95% CI, 9-14) of patients, respectively. The clinical and study-related variables included in subgroup analysis and mixed-effect model explained only a very small part of the inter-study heterogeneity.
In patients in whom anticoagulation was withheld, the rate of SVT recanalization, SVT progression, recurrent VTE, major bleeding, and overall mortality were 22% (95% CI, 15-31), 16% (95% CI, 8-28), 14% (95% CI, 10-21), 16% (95% CI, 13-20), and 25% (95% CI, 20-31), respectively. Forty-nine studies which compared anticoagulation with no treatment showed significant higher recanalization rates (RR 2.39; 95% CI, 1.66-3.44) and lower rates of thrombosis progression (RR 0.24; 95% CI, 0.13-0.42), major bleeding (RR 0.73; 95% CI, 0.58-0.92), and overall mortality (RR 0.45; 95% CI, 0.33-0.60) in patients receiving anticoagulation.

Conclusions: Anticoagulant therapy improves SVT recanalization and reduces the risk of thrombus progression, without increasing major bleeding rates. The incidence of recurrent VTE remains substantial also in anticoagulated patients.

To cite this abstract in AMA style:

Valeriani E, Di Nisio M, Riva N, Cohen O, Garcia-Pagan J-, Magaz M, Porreca E, Ageno W. Anticoagulant Therapy for Splanchnic Vein Thrombosis: A Systematic Review and Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulant-therapy-for-splanchnic-vein-thrombosis-a-systematic-review-and-meta-analysis/. Accessed September 21, 2023.

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