Semin Thromb Hemost 2015; 41(05): 503-513
DOI: 10.1055/s-0035-1550429
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors, Diagnosis, Management, and Outcome of Splanchnic Vein Thrombosis: A Retrospective Analysis

Benjamin A. Derman
1   Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
,
Hau C. Kwaan
2   Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. Juni 2015 (online)

Abstract

Objectives This study aims to determine the risk factors, diagnostic methods employed, treatment modalities, and outcome in patients with splanchnic vein thrombosis (SVT).

Methods A retrospective chart review of patients, age 18 to 90 years, diagnosed with SVT at a single institution from January 1, 2010 to November 10, 2012. They were grouped as portal vein thrombosis (PVT)—including those combined with splenic vein thrombosis (SPVT) or mesenteric vein thrombosis (MVT)—and Budd–Chiari syndrome (BCS).

Results Overall 246 SVT patients were identified, including 225 PVT and 21 BCS. Risk factors were liver disease, upper abdominal (regional) cancer and surgery, pancreatitis, and hereditary thrombophilia. The most common symptom was abdominal pain and most patients had abnormal liver function. Among those tested, the JAK2 V617F mutation was present in only 20% of the patients with PVT and 14% of the patients with BCS. Most patients were diagnosed by computed tomography. Anticoagulants were given to 30% of the patients with PVT and to 60% of the patients with BCS, with recurrence of SVT in 15% of the patients with PVT and 24% of the patients with BCS, regardless of anticoagulation.

Conclusion As compared with published literature on SVT, we found a higher incidence of regional cancer and surgery and a lower incidence of the JAK2 V617F mutation.

 
  • References

  • 1 Donadini MP, Dentali F, Ageno W. Splanchnic vein thrombosis: new risk factors and management. Thromb Res 2012; 129 (Suppl. 01) S93-S96
  • 2 De Stefano V, Martinelli I. Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med 2010; 5 (6) 487-494
  • 3 Kiladjian J-J, Cervantes F, Leebeek FWG , et al. The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood 2008; 111 (10) 4922-4929
  • 4 Dentali F, Squizzato A, Brivio L , et al. JAK2V617F mutation for the early diagnosis of Ph- myeloproliferative neoplasms in patients with venous thromboembolism: a meta-analysis. Blood 2009; 113 (22) 5617-5623
  • 5 Primignani M, Barosi G, Bergamaschi G , et al. Role of the JAK2 mutation in the diagnosis of chronic myeloproliferative disorders in splanchnic vein thrombosis. Hepatology 2006; 44 (6) 1528-1534
  • 6 Bergamaschi GM, Primignani M, Barosi G , et al. MPL and JAK2 exon 12 mutations in patients with the Budd-Chiari syndrome or extrahepatic portal vein obstruction. Blood 2008; 111 (8) 4418-4418
  • 7 Klampfl T, Gisslinger H, Harutyunyan AS , et al. Somatic mutations of calreticulin in myeloproliferative neoplasms. N Engl J Med 2013; 369 (25) 2379-2390
  • 8 Nangalia J, Massie CE, Baxter EJ , et al. Somatic CALR mutations in myeloproliferative neoplasms with nonmutated JAK2. N Engl J Med 2013; 369 (25) 2391-2405
  • 9 Smalberg JH, Arends LR, Valla DC, Kiladjian J-J, Janssen HLA, Leebeek FWG. Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis. Blood 2012; 120 (25) 4921-4928
  • 10 Riva N, Donadini MP, Dentali F, Squizzato A, Ageno W. Clinical approach to splanchnic vein thrombosis: risk factors and treatment. Thromb Res 2012; 130 (Suppl. 01) S1-S3
  • 11 Schumann G, Bonora R, Ceriotti F , et al; International Federation of Clinical Chemistry and Laboratory Medicine. IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37 degrees C. International Federation of Clinical Chemistry and Laboratory Medicine. Part 5. Reference procedure for the measurement of catalytic concentration of aspartate aminotransferase. Clin Chem Lab Med 2002; 40 (7) 725-733
  • 12 Siekmann L, Bonora R, Burtis CA , et al; International Federation of Clinical Chemistry and Laboratory Medicine. IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37 degrees C. International Federation of Clinical Chemistry and Laboratory Medicine. Part 7. Certification of four reference materials for the determination of enzymatic activity of gamma-glutamyltransferase, lactate dehydrogenase, alanine aminotransferase and creatine kinase accord. Clin Chem Lab Med 2002; 40 (7) 739-745
  • 13 Raffa S, Reverter JC, Seijo S , et al. Hypercoagulability in patients with chronic noncirrhotic portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10 (1) 72-78
  • 14 Sutkowska E, McBane RD, Tafur AJ , et al. Thrombophilia differences in splanchnic vein thrombosis and lower extremity deep venous thrombosis in North America. J Gastroenterol 2013; 48 (10) 1111-1118
  • 15 Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H. Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol 2007; 7: 34
  • 16 Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 2010; 254 (1) 154-162
  • 17 Shah TU, Semelka RC, Voultsinos V , et al. Accuracy of magnetic resonance imaging for preoperative detection of portal vein thrombosis in liver transplant candidates. Liver Transpl 2006; 12 (11) 1682-1688
  • 18 Kearon C, Akl EA, Comerota AJ , et al; American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e419S-e494S
  • 19 Pannach S, Babatz J, Beyer-Westendorf J. Successful treatment of acute portal vein thrombosis with rivaroxaban. Thromb Haemost 2013; 110 (4) 626-627
  • 20 Englesbe MJ, Kubus J, Muhammad W , et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010; 16 (1) 83-90
  • 21 Pécora RAA, Canedo BF, Andraus W , et al. Portal vein thrombosis in liver transplantation. Arq Bras Cir Dig 2012; 25 (4) 273-278
  • 22 Levine RL. Another piece of the myeloproliferative neoplasms puzzle. N Engl J Med 2013; 369 (25) 2451-2452