Background: Splanchnic vein thrombosis (SVT) occurs in a heterogenous group of patients secondary to a variety of risk factors including liver disease. There is equipoise regarding the utility of anticoagulation in cirrhotic patients with SVT.

Aims: We sought to identify clinical factors predictive of new or progressive thrombosis in a cohort of patients with untreated SVT, with the goal of identifying patients most likely to benefit from therapeutic anticoagulation.

Methods: This was a retrospective cohort study of cirrhotic patients over 18 years of age diagnosed with an SVT at the Oregon Health & Science University from 2015 –2020, including only patients who were not initially treated with anticoagulation. The primary study endpoint was a composite of the following: imaging-confirmed progression of SVT, development of cavernous transformation, intestinal ischemia, portal cholangiopathy or new venous or arterial thrombosis.

Results: 261 patients were included in the analysis. Forty percent of all patients experienced the primary composite endpoint. Multivariable logistic regression found that only the presence of pancreatitis or abdominal infection at diagnosis was associated with increased likelihood of experiencing the primary composite endpoint (OR 3.61, P= 0.02). Attempts to derive an integer-based risk model found an AUC that was only marginally higher than that of chance alone (0.57). However, there was a statistically significant difference of overall survival between patients that did and did not experience the primary composite endpoint.

Conclusion(s): Overall, only the presence of pancreatitis or active intra-abdominal infection was found to be predictive of thrombotic progression in patients with cirrhosis and SVT. Predictive modeling implies that the risk factors for thrombus progression are heterogenous. Thrombotic progression was associated with increased mortality.

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Figure 1. Kaplan-Meier Survival Curves for Patients with Splanchnic Vein Thrombosis. Kaplan-Meier survival curves are provided for the full cohort of patients with splanchnic vein thrombosis -A- and grouped by composite outcome -B-. As with the other analyses, patients who died prior to 30 days were removed to ensure at least 30 days risk of developing the composite event.

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Figure 2: ROC curves for logistic regression -left- and integer score -right- generated to determine the strength of the model in predicting the composite outcome

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/identifying-clinical-predictors-for-thrombus-progression-in-cirrhotic-patients-with-untreated-splanchnic-vein-thrombosis/