Abstract Number: PB0431
Meeting: ISTH 2022 Congress
Background: Robust evidence on the optimal management of splanchnic vein thrombosis (SVT) is lacking and guideline recommendations are heterogeneous.
Aims: To evaluate the effectiveness and safety of anticoagulation for SVT.
Methods: This individual patient data meta-analysis was performed according to the PRISMA guideline. We searched MEDLINE and EMBASE up to June 2021 and clincaltrial.gov. Data from individual datasets were verified, merged, and any discrepancy with published data was resolved by contacting study authors. Main effectiveness outcomes were recurrent venous thromboembolism (VTE) and mortality; the main safety outcome was major bleeding. Incidence rates were expressed as number of events per 100 patient-years (/100 p-y) with relative 95% confidence intervals (95% CI). Hazard ratios (HRs) were estimated with Cox proportional models considering anticoagulant treatment as time-varying.
Results: A total of 1635 patients were included from 3 studies. Eighty-five percent of patients received anticoagulation for a median duration of 316 days (range 1 to 730 days). Overall, incidence rates for recurrent VTE, major bleeding, and mortality were 5.3/100 p-y (95% CI, 5.1 to 5.5), 4.4/100 p-y (95% CI, 4.2 to 4.6), and 13.0/100 p-y (95% CI, 12.4 to 13.6), respectively. The incidence rates of all outcomes were lower during anticoagulation and higher after treatment discontinuation or when anticoagulation was not administered. In multivariable analysis, anticoagulant treatment appeared to be associated with a lower risk of recurrent VTE (HR 0.42; 95% CI, 0.27 to 0.64), major bleeding (HR 0.48; 95% CI, 0.30 to 0.75), and mortality (HR 0.23; 95% CI, 0.18 to 0.31). Results were consistent in patients with cirrhosis, solid cancer, myeloproliferative neoplasms, unprovoked SVT, and SVT associated with transient or persistent non-malignant risk factors.
Conclusion(s): In patients with SVT the risk of recurrent VTE and major bleeding is substantial. Anticoagulant treatment is associated with reduced risk of both outcomes.
To cite this abstract in AMA style:Candeloro M, Valeriani E, Monreal M, Ageno W, Riva N, Lopez Reyes R, Peris M, Beyer Westendorf J, Schulman S, Rosa V, LÓPEZ-NÚÑEZ J, Garcia-Pagan J, Magaz M, Senzolo M, De Gottardi A, Di Nisio M. Anticoagulant therapy for splanchnic vein thrombosis: an individual patient data meta-analysis [abstract]. https://abstracts.isth.org/abstract/anticoagulant-therapy-for-splanchnic-vein-thrombosis-an-individual-patient-data-meta-analysis/. Accessed August 16, 2022.
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