Cancer-Associated Splanchnic Vein Thrombosis

Omri Cohen, Lucia Maria Caiano, Antonella Tufano, Walter Ageno

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Splanchnic vein thrombosis (SVT), which includes portal, mesenteric, and splenic vein thrombosis and the Budd-Chiari syndrome, is an infrequent manifestation of venous thromboembolism (VTE). Like typical site VTE, SVT is also frequently associated with cancer, particularly intra-abdominal solid malignancies and myeloproliferative neoplasms (MPNs). The clinical presentation of SVT is nonspecific. Symptoms may be related to the underlying malignancy, and thrombosis is incidentally diagnosed by imaging studies for cancer staging or follow-up in a substantial proportion of cases. The occurrence of SVT predicts worse prognosis in patients with liver or pancreatic cancer and, not uncommonly, SVT may precede the diagnosis of cancer. Therefore, the occurrence of an apparently unprovoked SVT should prompt careful patient evaluation for the presence of an underlying malignancy or MPN. Cancer patients carry a high risk of VTE extension and recurrence and long-term anticoagulant treatment is suggested in the absence of high risk of bleeding. Either LMWH or direct oral anticoagulants (DOACs) are suggested for the treatment of patients with cancer-related SVT, although limited experience is available on the use of DOACs in these settings. Vitamin K antagonists (VKAs) are suggested for the short and long-term treatment of SVT associated with MPN. This review outlines the epidemiological aspects, pathogenesis, risk factors, and diagnosis of cancer-associated SVT, and addresses questions regarding the management of this challenging condition.

Original languageEnglish
Pages (from-to)931-941
Number of pages11
JournalSeminars in Thrombosis and Hemostasis
Volume47
Issue number8
StatePublished - Nov 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Thieme Medical Publishers, Inc.. All rights reserved.

Keywords

  • anticoagulation
  • cancer
  • myeloproliferative neoplasms
  • splanchnic vein thrombosis
  • venous thromboembolism

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