Thrombus Resolution in Splanchnic Vein Thrombosis
ISTH Academy. Casanegra A. Jul 10, 2019; 273917; OC 73.4
Dr. Ana Casanegra
Dr. Ana Casanegra
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OC 73.4

Thrombus Resolution in Splanchnic Vein Thrombosis

A.I. Casanegra1, D.T. Vlazny1, P.S. Kamath2, D.O. Hodge3, W.E. Wysokinski1
1Mayo Clinic Rochester, Cardiovascular Medicine, Rochester, United States, 2Mayo Clinic Rochester, Gastroenterology and Hepatology, Rochester, United States, 3Mayo Clinic Jacksonville, Health Sciences Research, Jacksonville, United States

Main Topic: Venous Thromboembolism
Category: DOACs

Background: Direct oral anticoagulants (DOACs) are commonly used in clinical practice to treat splanchnic vein thrombosis. Registries suggest similar rates of complications compared with warfarin but recanalization has not been evaluated.
Aims: Determine the rate of recanalization of the splanchnic (portal) veins in patients treated with DOACs vs other anticoagulants.
Methods: Consecutive patients with acute splanchnic vein thrombosis enrolled in the Mayo Thrombophilia Clinic Anticoagulants Registry (3/1/2013 -8/30/2018) were followed forward in time. Patients were included if they had anticoagulants started within the first 14 days of diagnosis and completed at least 3 months of therapy. Recanalization was evaluated at 3 months or later by independent review of available CT or ultrasound.
Results: Among 75 patients, 72% had portal vein thrombosis, 37% mesenteric, 1% splenic, and more than one vein (usually portal and superior mesenteric vein) was involved in 11%. Half of the patients were males (53%). Half of the patients had active cancer (57%). The most common cancers were pancreatic (30%) and gastrointestinal tract (33%). DOACs were the most common anticoagulants (63%), followed by low molecular weight heparin (LMWH) (29%) and warfarin(8%)
Follow up imaging was obtained on average at 108 days (range 13-466) and was done by CT scan in 81% of the patients and was missing in 13%. Recanalization was complete in 32% of the patients, partial in 21%. There was no improvement in 21% and progression in 1%. Recanalization was more likely in patients without cancer (83% vs 44%, p=0.002). There was no statistical difference in recanalization by anticoagulant in patients with cancer (p=0.14 LMWH vs Doacs). Recanalization was more likely in patients treated with DOACs than LMWH or warfarin (p< 0.001) but cancer could be a confounding factor.
Conclusions: Malignancy associated splanchnic thromboses are less likely to recanalize. Recanalization is not statistically significant improved with DOACs.

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