Splanchnic Venous Thrombosis, with Spotlight on Occult Malignancies, Anticoagulation, and Bleeding

Abstract

Objective: Splanchnic venous thrombosis (SVT) conceptually embraces thrombosis in the portal, hepatic, splenic, and mesenteric venous system thrombosis. The SVT risk factors may be classified as abdominal disorders, underlying myeloproliferative neoplasms (MPN), inherited thrombophilic syndromes, and autoimmune disorders. The aim of our study is to evaluate the risk factors for SVT and their relations with the localization of involvement and anticoagulation during the acute period and relation to major bleeding.

Methods: All patients with portal vein thrombosis or splenic venous thrombosis in their radiologic evaluation report were included over a 5-year period.

Results: Of the 96 patients, 87 had an identifiable risk factor for SVT (90.6%). The major risk factor was cirrhosis (60 patients, 62.5%). Other risk factors included thrombophilic conditions (12 patients, 12.6%), 6 patients had the myeloproliferative disorder (6.3%), and most interestingly, 24 had occult malignancy for which SVT was the presenting factor (25%). Within the whole group, 51 patients (53.1%) received anticoagulant treatment. Within the whole group, 30 patients developed major bleeding (31.3%), and 20 of these patients did not receive anticoagulation therapy. Twenty-five of the patients with cirrhosis suffered bleeding, and 18 of them did not receive anticoagulation therapy.

Conclusion: Almost all patients with SVT had an identifiable risk factor. The follow-up and further treatments should be based on this risk factor. SVT may be the presenting finding of occult malignancies and occult malignancy should be investigated in every patient with SVT. Anticoagulation during the initial acute period should not be withheld, even in patients with the chronic liver disease with a concern for major bleeding.