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splanchnic vein thrombosis (SVT)

Etiology: - hypercoagulability of malignancy - JAK2 V617F mutation [3,4] - ingestion of a foreign body (fish bone), with penetration of the duodenum, pancreas, & superior mesenteric vein (case report) [2] Pathology: - portal vein thrombosis (78%) - hepatic vein thrombosis - mesenteric vein thrombosis - superior mesenteric vein thrombosis - inferior mesenteric vein thrombosis - splenic vein thrombosis Laboratory: - D-dimer level may be elevated - JAK2 V617F mutation Complications: - 3-month cancer risk is 8% - predicts near-term appearance of liver cancer & pancreatic cancer with a poor prognosis [1] - increased risk of smoking-related cancers (lung cancer, gastrointestinal cancer, & urologic cancer) 3-14 fold [1] Management: - surgical consult if intestinal infarction, peritonitis, shock, lactic acidosis, or major hemorrhage [5] - upper GI endoscopy to evaluate for varices if risk for portal hypertension [5] - avoid thrombolysis (systemic or catheter-directed) unless intestinal ischemia is suspected or deterioration despite anticoagulation [5] - anticoagulation - >= 3-6 months of anticoagulation for acute or incidentally discovered SVT - consider direct oral anticoagulants (DOACs) in noncirrhotic patients - LMY heparin is preferred in patients with cirrhosis - vitamin K antagonists (warfarin) are alternatives - lifelong anticoagulation - patients with Budd-Chiari syndrome - consider for patients with unprovoked SVT - progression after discontinuation of anticoagulant - persisting thrombotic risk factors [5]

Related

hypercoagulability associated with malignancy visceral; splanchnic

Specific

hepatic vein thrombosis (Budd-Chiari syndrome) mesenteric vein thrombosis portal vein thrombosis renal vein thrombosis

General

deep vein thrombosis (DVT)

References

  1. Sogaard KK et al. Splanchnic venous thrombosis is a marker of cancer and a prognostic factor for cancer survival. Blood 2015 Jun 18 PMID: 26089394
  2. Gharib SD et al Case 21-2015 - A 37-Year-Old American Man Living in Vietnam, with Fever and Bacteremia. N Engl J Med 2015; 373:174-183. July 9, 2015 PMID: 26154791 http://www.nejm.org/doi/full/10.1056/NEJMcpc1411439
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  4. Yonal I et al The clinical significance of JAK2V617F mutation for Philadelphia-negative chronic myeloproliferative neoplasms in patients with splanchnic vein thrombosis. PMID: 22569900
  5. Di Nisio M et al. Anticoagulant therapy for splanchnic vein thrombosis: ISTH SSC Subcommittee Control of Anticoagulation. J Thromb Haemost 2020 Jul; 18:1562. PMID: 32619346 https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14836