Anticoagulation and Vessel Recanalization in Cirrhotic Patients with Splanchnic Vein Thrombosis: A Multidisciplinary 'Real Life' Experience

Serena Rupoli,1 Alessandro Fiorentini,1 Erika Morsia,1 Gianluca Svegliati-Baroni,2 Giorgia Micucci,1 Luca Maroni,2 Kimberly Blaine Garvey,1 Alessandro Fiorentini Snr,3 Alessandra Riva Snr,4 Lidia Da Lio,5 Antonio Benedetti,2 Massimo Offidani,1 Attilio Olivieri,1 Tarantino Giuseppe2 1Clinica Ematologica, Dipartimento di Medicina Interna, Ancona, Italy; 2SOD Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d’Urgenza, Ancona, Italy; 3SOD Malattie Infettive emergenti e degli immunodepressi, Ospedali Riuniti Ancona, Ancona, Italy; 4SOD Clinica Malattie Infettive tropicali, parassitologia, epatiti croniche, Ancona, Italy; 5SOD Medicina di Laboratorio, Ospedali Riuniti Ancona, Ancona, ItalyCorrespondence: Erika MorsiaClinica Ematologica, Ospedali Riuniti Ancona, via Conca 71, 60126, ItalyEmail erika.morsia@ospedaliriuniti.marche.itBackground and Aim: Splanchnic vein thrombosis (SVT) is a potentially life-threatening complication of liver cirrhosis. This study aimed to evaluate the impact of a multi-disciplinary approach and early anticoagulation therapy (AT) on bleeding/thrombotic events, recanalization rates and outcome of cirrhotic patients with SVT.Methods: This is a single-center, registry-based cohort study. Over 17 years, 149 SVT patients were enrolled and prospectively evaluated. Regarding cirrhotic-SVT, a pre-specified algorithm, guiding initial posology of AT and follow-up visits schedule, was performed. Major bleeding (MB), thrombotic events, functional liver scores and all cause-mortality were investigated. Efficacy of AT was evaluated by radiological imaging.Results: In cirrhotic-SVT, the incidence rate of MB was 8.4 per 100 patient-year (95% CI, 3.83– 15.97), while the incidence rate of thrombosis was 5.6 per 100 patient-year (95% CI, 2.05– 12.2). In incidental SVT treated with AT, MB incidence was 6.5 per 100 patient-year (95% CI: 2.8– 12.82), while in symptomatic SVT was 2.2 per 100 patient-year (95% CI: 0.25– 8.02). All thrombotic recurrences occurred in incidental SVT (7.7 per 100 patient-years; 95% CI, 3.71– 14.26). Overall survival was significantly higher in patients who had at least a partial recanalization (p < 0.01) and partial/total recanalization was independently associated with improved MELD score at multivariate analysis (HR 2.62, 95% CI 1.1– 6.47, p = 0.03).Conclusion: In cirrhotic SVT patients, partial or total resolution of thrombosis ameliorates liver function and is associated with higher overall survival. A multidisciplinary approach together with radiological follow-up at pre-fixed time improves patient selection and monitoring.Keywords: splanchnic vein thrombosis, cirrhosis, anticoagulant therapy, vessel recanalization, multidisciplinary approach