Incidence and factors predictive of recurrent thrombosis in patients with non-cirrhotic portal vein thrombosis.
Publisher DOI
PubMed ID
36058365
Abstract
BACKGROUND AND AIMS
Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that there is a very low risk of recurrent thrombosis (RT). Our first aim was to describe the incidence of RT in patients with NC-SVT without indication for long-term anticoagulation. The second aim was to identify RT risk factors and afterwards verify them in a validation cohort.
METHODS
Multicenter retrospective observational study evaluating risk factors for RT in 64 patients with NC-SVT of idiopathic/local etiology. In a subgroup of 48 patients the potential value of additional thrombophilic parameters to predict RT was analyzed. Findings were validated in 70 independent patients with idiopathic/local NC-SVT.
RESULTS
Of the 64 patients, 17 (26%) presented splanchnic and/or extra-splanchnic RT (overall-RT) during follow-up (cumulative incidence: 2%, 10%, 19% and 34% at 1, 2, 5 and 10 years). 53% of splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 patients with additional comprehensive thrombophilic study, factor VIII ≥ 150% was the only independent factor predicting overall-RT (HR 7.10 (CI 2.17 - 23.17) p< 0.01). In the validation cohort 19 patients (27%) presented overall-RT, and it was also independently predicted by factor VIII > 150% (HR 3.71 (1.31 - 10.5), p < 0.01). The predictive value of factor VIII was confirmed both in patients with idiopathic and with local etiology.
CONCLUSIONS
Patients with idiopathic/local NC-SVT are at risk of overall-RT. Splanchnic RT can be asymptomatic and requires screening for its detection. Values of factor VIII ≥ 150% may help identify patients at high risk of overall-RT who could benefit from long-term anticoagulation.
LAY SUMMARY
Patients with idiopathic/isolated local factor non cirrhotic splanchnic vein thrombosis (NC-SVT) were previously thought to be at minimal risk of rethrombosis. Our results show a 25% incidence of rethrombosis and support the indication of close follow-up to identify new thrombotic events, specially in patients with factor VIII >150%.
Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that there is a very low risk of recurrent thrombosis (RT). Our first aim was to describe the incidence of RT in patients with NC-SVT without indication for long-term anticoagulation. The second aim was to identify RT risk factors and afterwards verify them in a validation cohort.
METHODS
Multicenter retrospective observational study evaluating risk factors for RT in 64 patients with NC-SVT of idiopathic/local etiology. In a subgroup of 48 patients the potential value of additional thrombophilic parameters to predict RT was analyzed. Findings were validated in 70 independent patients with idiopathic/local NC-SVT.
RESULTS
Of the 64 patients, 17 (26%) presented splanchnic and/or extra-splanchnic RT (overall-RT) during follow-up (cumulative incidence: 2%, 10%, 19% and 34% at 1, 2, 5 and 10 years). 53% of splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 patients with additional comprehensive thrombophilic study, factor VIII ≥ 150% was the only independent factor predicting overall-RT (HR 7.10 (CI 2.17 - 23.17) p< 0.01). In the validation cohort 19 patients (27%) presented overall-RT, and it was also independently predicted by factor VIII > 150% (HR 3.71 (1.31 - 10.5), p < 0.01). The predictive value of factor VIII was confirmed both in patients with idiopathic and with local etiology.
CONCLUSIONS
Patients with idiopathic/local NC-SVT are at risk of overall-RT. Splanchnic RT can be asymptomatic and requires screening for its detection. Values of factor VIII ≥ 150% may help identify patients at high risk of overall-RT who could benefit from long-term anticoagulation.
LAY SUMMARY
Patients with idiopathic/isolated local factor non cirrhotic splanchnic vein thrombosis (NC-SVT) were previously thought to be at minimal risk of rethrombosis. Our results show a 25% incidence of rethrombosis and support the indication of close follow-up to identify new thrombotic events, specially in patients with factor VIII >150%.
Date Issued
2023-01
Publication Type
Article
Subject(s)
Subjects
Coagulation extra-splanchnic thrombotic event factors VIII imaging follow-up long-term anticoagulation re-thrombosis
Language(s)
en
Author(s)
Baiges, Anna | |
Procopet, Bogdan | |
Silva-Junior, Gilberto | |
Llop, Elba | |
Tellez, Luis | |
Darnell, Anna | |
Garcia-Criado, Ángeles | |
Turon, Fanny | |
Nicoara-Farcau, Oana | |
González-Alayón, Carlos | |
Larrue, Hélène | |
Magaz, Marta | |
Olivas, Pol | |
Perez-Campuzano, Valeria | |
Calleja, Jose Luis | |
Albillos, Agustin | |
Reverter, Juan Carlos | |
Bureau, Christophe | |
Hernández-Gea, Virginia | |
Garcia-Pagán, Juan Carlos |
Additional Credits
Journal
Journal of hepatology
Publisher
Elsevier
ISSN
1600-0641
Access(Rights)
open.access