Anticoagulant therapy for splanchnic vein thrombosis: a systematic review and meta-analysis
- PMID: 32911539
- DOI: 10.1182/blood.2020006827
Anticoagulant therapy for splanchnic vein thrombosis: a systematic review and meta-analysis
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.
© 2021 by The American Society of Hematology.
Comment in
-
Treating SVT: more than just a "gut feeling".Blood. 2021 Mar 4;137(9):1141. doi: 10.1182/blood.2020008962. Blood. 2021. PMID: 33661289 No abstract available.
Similar articles
-
Anticoagulation Therapy for Splanchnic Vein Thrombosis Associated With Acute Pancreatitis: A Systematic Review and Meta-Analysis.Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231188718. doi: 10.1177/10760296231188718. Clin Appl Thromb Hemost. 2023. PMID: 37461391 Free PMC article.
-
Anticoagulant treatment for pediatric splanchnic vein thrombosis: a systematic review and meta-analysis.J Thromb Haemost. 2023 Sep;21(9):2499-2508. doi: 10.1016/j.jtha.2023.05.014. Epub 2023 May 22. J Thromb Haemost. 2023. PMID: 37225019
-
Anticoagulant Treatment for Splanchnic Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis.Thromb Haemost. 2021 Jul;121(7):867-876. doi: 10.1055/s-0040-1722192. Epub 2021 Feb 1. Thromb Haemost. 2021. PMID: 33525037
-
Medical management of acute superficial vein thrombosis of the saphenous vein.J Vasc Surg Venous Lymphat Disord. 2018 Jan;6(1):109-117. doi: 10.1016/j.jvsv.2017.08.016. Epub 2017 Oct 31. J Vasc Surg Venous Lymphat Disord. 2018. PMID: 29097174 Review.
-
Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Eur J Intern Med. 2015 Jan;26(1):23-9. doi: 10.1016/j.ejim.2014.12.002. Epub 2015 Jan 5. Eur J Intern Med. 2015. PMID: 25566699 Review.
Cited by
-
Current concepts in the management of non-cirrhotic non-malignant portal vein thrombosis.World J Hepatol. 2024 May 27;16(5):751-765. doi: 10.4254/wjh.v16.i5.751. World J Hepatol. 2024. PMID: 38818283 Free PMC article. Review.
-
Systemic Thrombolysis for Isolated Splenic Vein Thrombosis Secondary to Oral Contraceptives: A Case Report.Int J Womens Health. 2024 May 13;16:811-818. doi: 10.2147/IJWH.S462610. eCollection 2024. Int J Womens Health. 2024. PMID: 38765206 Free PMC article.
-
Adrenal infarction with latent myelodysplastic/myeloproliferative neoplasm, unclassifiable with JAK2V617F mutation.Clin Case Rep. 2024 Apr 9;12(4):e8729. doi: 10.1002/ccr3.8729. eCollection 2024 Apr. Clin Case Rep. 2024. PMID: 38601172 Free PMC article.
-
Venous Thrombosis in Acute Pancreatitis: What to and Not to Do?Dig Dis Sci. 2024 May;69(5):1537-1550. doi: 10.1007/s10620-024-08418-5. Epub 2024 Apr 10. Dig Dis Sci. 2024. PMID: 38600412 Review.
-
Natural history of cancer-associated splanchnic vein thrombosis.J Thromb Haemost. 2024 May;22(5):1421-1432. doi: 10.1016/j.jtha.2024.01.019. Epub 2024 Feb 1. J Thromb Haemost. 2024. PMID: 38309433
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical