Anticoagulant therapy for splanchnic vein thrombosis: a systematic review and meta-analysis

Emanuele Valeriani, Marcello Di Nisio, Nicoletta Riva, Omri Cohen, Juan Carlos Garcia-Pagan, Marta Magaz, Ettore Porreca, Walter Ageno

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Treatment of splanchnic vein thrombosis (SVT) is challenging, and evidence to guide therapeutic decisions remains scarce. The objective of this systematic review and meta-analysis was to determine the efficacy and safety of anticoagulant therapy for SVT. MEDLINE, EMBASE, and clinicaltrials.gov were searched from inception through December 2019, without language restrictions, to include observational studies and randomized controlled trials reporting radiological or clinical outcomes in patients with SVT. Pooled proportions and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effects model. Of 4312 records identified by the search, 97 studies including 7969 patients were analyzed. In patients receiving anticoagulation, the rates of SVT recanalization, SVT progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were 58% (95% CI, 51-64), 5% (95% CI, 3-7), 11% (95% CI, 8-15), 9% (95% CI, 7-12), and 11% (95% CI, 9-14), respectively. The corresponding values in patients without anticoagulation were 22% (95% CI, 15-31), 15% (95% CI, 8-27), 14% (95% CI, 9-21), 16% (95% CI, 13-20), and 25% (95% CI, 20-31). Compared with no treatment, anticoagulant therapy obtained higher recanalization (RR, 2.39; 95% CI, 1.66-3.44) and lower thrombosis progression (RR, 0.24; 95% CI, 0.13-0.42), major bleeding (RR, 0.73; 95% CI, 0.58-0.92), and overall mortality (RR, 0.45; 95% CI, 0.33-0.60). These results demonstrate that anticoagulant therapy improves SVT recanalization and reduces the risk of thrombosis progression without increasing major bleeding. The incidence of recurrent VTE remained substantial in patients receiving anticoagulation, as well. Effects were consistent across the different subgroups of patients. This trial was registered on the PROPERO database at (https://www.crd.york.ac.uk/prospero//display_record.php?ID=CRD42019127870) as #CRD42019127870. Key Points: • Anticoagulant therapy was associated with a high rate of splanchnic vein recanalization and a low rate of thrombosis progression. • Major bleeding risk and overall mortality of patients with splanchnic vein thrombosis were reduced by anticoagulant therapy.

Original languageEnglish
Pages (from-to)1233-1240
Number of pages8
JournalBlood
Volume137
Issue number9
DOIs
StatePublished - 4 Mar 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 American Society of Hematology

Fingerprint

Dive into the research topics of 'Anticoagulant therapy for splanchnic vein thrombosis: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this