Survival and Recurrence in Patients With Splanchnic Vein Thromboses

• Published in: Clinical gastroenterology and hepatology Vol. 8; no. 2; pp. 200 - 205
• Main Authors: Thatipelli, Mallikarjun R, McBane, Robert D, Hodge, David O, Wysokinski, Waldemar E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2010
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Case-Control Studies; Female; Gastroenterology and Hepatology; Hepatic Veins - pathology; Humans; Male; Mesenteric Veins - pathology; Middle Aged; Portal Vein - pathology; Recurrence; Splenic Vein - pathology; Survival Analysis; Thrombosis - mortality; hazard ratio; confidence interval; HR; DVT; deep venous thrombosis; CI
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2009.09.019

Background & Aims Hepatic, splenic, portal, and mesenteric veins are confluent elements within the splanchnic system. It is therefore unclear whether thromboses of isolated segments represent unique entities. We compared etiologies, recurrence, and survival of patients with thromboses of different splanchnic venous segments. Methods An inception cohort of individuals was identified with first lifetime incident of splanchnic vein thrombosis between 1980 and 2000. We performed a case-controlled comparison of recurrent thrombosis and survival data with those of patients with deep venous thrombosis (DVT). Results The study (832 patients; mean age, 53 ± 17 years; 42% women) included patients with isolated portal (n = 329), mesenteric (n = 76), splenic (n = 62), and hepatic (n = 45) vein thrombosis and patients with multisegment involvement (n = 320). Malignancy (27%) and cirrhosis (24%) were the most common etiologies. Recurrence-free survival 10 years after splanchnic vein thrombosis (76%) was comparable with that after DVT (68%) and not improved by anticoagulant therapy. Hormone therapy was the only independent predictor of recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09–4.45; P = .03). Major bleeding was 6.9/100 patient-years. Gastroesophageal varices (HR, 2.63; 95% CI, 1.72–4.03; P < .001) and warfarin therapy (HR, 1.91, 95% CI, 1.25–2.92; P = .003) were independent predictors of bleeding. The 10-year survival rate of patients with splanchnic vein thrombosis (60%) was lower than that of patients with DVT (68%, P < .05). Older age (HR, 1.03; 95% CI, 1.02–1.03), active cancer (HR, 2.23; 95% CI, 1.78–2.78), and myeloproliferative disorder (HR, 1.92; 95% CI, 1.41–2.61) were independent determinants of mortality ( P < .001). Conclusions Splanchnic vein thrombosis depends on the pathology of the organ supplied. On the basis of the low rate of recurrence and substantial rate of major hemorrhage, prolonged anticoagulant therapy does not appear to be justified.