Highlights
- •Individuals with non-cirrhotic splanchnic thrombosis without thrombophilia are at risk of re-thrombosis.
- •Splanchnic re-thrombosis can be asymptomatic and requires screening for its detection.
- •Factor VIII ≥150% may help identify individuals at higher risk of re-thrombosis.
Background & Aims
Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic
vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that
there is a very low risk of recurrent thrombosis (RT). Our first aim was to describe
the incidence of RT in people with NC-SVT without an indication for long-term anticoagulation.
The second aim was to identify RT risk factors and afterwards verify them in a validation
cohort.
Methods
This is a multicentre, retrospective observational study evaluating risk factors for
RT in 64 people with NC-SVT of idiopathic/local factor aetiology. In a subgroup of
48 individuals, the potential value of additional thrombophilic parameters to predict
RT was analysed. Findings were validated in 70 individuals with idiopathic/local factor
NC-SVT.
Results
Of the 64 participants in the training cohort, 17 (26%) presented splanchnic and/or
extrasplanchnic RT (overall-RT) during follow-up (cumulative incidence: 2, 10, 19,
and 34% at 1, 2, 5, and 10 years, respectively). In addition, 53% of people with splanchnic
RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT.
However, in the 48 people with an additional comprehensive thrombophilic study, factor
VIII ≥150% was the only independent factor predicting overall-RT (hazard ratio 7.10,
95% CI 2.17–23.17, p <0.01). In the validation cohort, 19 individuals (27%) presented overall-RT, and
it was also independently predicted by factor VIII >150% (hazard ratio 3.71, 95% CI
1.31–10.5, p <0.01). The predictive value of factor VIII was confirmed in both people with idiopathic/local
factor aetiology associated NC-SVT.
Conclusions
People with idiopathic/local factor NC-SVT are at risk of overall-RT. Splanchnic RT
can be asymptomatic and requires screening for its detection. Values of factor VIII
≥150% may help identify individuals at high risk of overall-RT who could benefit from
long-term anticoagulation.
Impact and implications
People with idiopathic/isolated local factor non-cirrhotic portal vein thrombosis
were previously thought to be at minimal risk of re-thrombosis and therefore did not
receive scheduled follow-up. The results of this study are of special interest for
hepatologists treating people with non-cirrhotic splanchnic thrombosis, as they show
a 25% incidence of re-thrombosis and support the close follow-up of people with factor
VIII >150% to ensure the early identification of new thrombotic events.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 01, 2022
Accepted:
August 10,
2022
Received in revised form:
July 15,
2022
Received:
March 9,
2022
Identification
Copyright
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
