Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment.

IF 2.7 4区 医学 Q2 HEMATOLOGY
Hamostaseologie Pub Date : 2024-08-01 Epub Date: 2024-02-14 DOI:10.1055/a-2232-5480
Scott Custo, Emma Tabone, Alexia Aquilina, Alex Gatt, Nicoletta Riva
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Abstract

Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism occurring within the splanchnic venous system. Portal vein thrombosis is the most common presentation, while Budd-Chiari syndrome is the least common. Liver cirrhosis and abdominal solid cancer are the main local risk factors for SVT, whereas myeloproliferative neoplasms are the predominant systemic risk factors. Signs and symptoms of SVT are nonspecific and include abdominal pain, gastrointestinal bleeding, and ascites. Asymptomatic SVT is not uncommon, and the majority would be detected incidentally on routine abdominal imaging performed for the follow-up of liver diseases and tumors. The management of SVT aims to prevent thrombus progression, promote vessel recanalization, and prevent recurrent venous thromboembolism. Anticoagulation should be started early in order to increase the chances of vessel recanalization and reduce the risk of portal hypertension-related complications. Direct oral anticoagulants have been included in recent guidelines, as alternatives to vitamin K antagonists, after clinical stability has been reached; however, caution is required in patients with liver or kidney dysfunction. Treatment duration is based on the presence (or absence) and type (transient vs. permanent) of risk factors. This narrative review aims to summarize the latest evidence on SVT, with a particular focus on the anticoagulant treatment in special categories of patients (e.g., liver cirrhosis, solid cancer, myeloproliferative neoplasms, pancreatitis, incidentally detected SVT, Budd-Chiari syndrome, and chronic SVT).

脾静脉血栓:抗凝治疗的最新进展。
脾静脉血栓(SVT)是一种罕见的发生在脾静脉系统内的静脉血栓栓塞症。门静脉血栓是最常见的表现形式,而巴-奇综合征(Budd-Chiari Syndrome)是最不常见的表现形式。肝硬化和腹腔实体肿瘤是 SVT 的主要局部危险因素,而骨髓增生性肿瘤则是主要的全身危险因素。SVT 的体征和症状是非特异性的,包括腹痛、消化道出血和腹水。无症状的 SVT 并不少见,大多数是在肝脏疾病和肿瘤的常规腹部造影检查中偶然发现的。处理 SVT 的目的是防止血栓发展、促进血管再通畅和预防复发性静脉血栓栓塞。应尽早开始抗凝治疗,以增加血管再通的机会,降低门静脉高压相关并发症的风险。直接口服抗凝剂作为维生素 K 拮抗剂的替代品,已被纳入近期的指南中,在达到临床稳定后使用;但肝脏或肾脏功能不全的患者需谨慎使用。治疗持续时间取决于风险因素的存在(或不存在)和类型(一过性与永久性)。本综述旨在总结有关 SVT 的最新证据,尤其关注特殊类别患者(如肝硬化、实体瘤、骨髓增生性肿瘤、胰腺炎、偶然发现的 SVT、Budd-Chiari 综合征和慢性 SVT)的抗凝治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hamostaseologie
Hamostaseologie HEMATOLOGY-
CiteScore
5.50
自引率
6.20%
发文量
62
审稿时长
6-12 weeks
期刊介绍: Hämostaseologie is an interdisciplinary specialist journal on the complex topics of haemorrhages and thromboembolism and is aimed not only at haematologists, but also at a wide range of specialists from clinic and practice. The readership consequently includes both specialists for internal medicine as well as for surgical diseases.
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