Survival and Recurrence in Patients With Splanchnic Vein Thromboses
published online 27 September 2009.
Background & Aims
Hepatic, splenic, portal, and mesenteric veins are confluent elements within the splanchnic system. It is therefore unclear whether thromboses of isolated segments represent unique entities. We compared etiologies, recurrence, and survival of patients with thromboses of different splanchnic venous segments.
Methods
An inception cohort of individuals was identified with first lifetime incident of splanchnic vein thrombosis between 1980 and 2000. We performed a case-controlled comparison of recurrent thrombosis and survival data with those of patients with deep venous thrombosis (DVT).
Results
The study (832 patients; mean age, 53 ± 17 years; 42% women) included patients with isolated portal (n = 329), mesenteric (n = 76), splenic (n = 62), and hepatic (n = 45) vein thrombosis and patients with multisegment involvement (n = 320). Malignancy (27%) and cirrhosis (24%) were the most common etiologies. Recurrence-free survival 10 years after splanchnic vein thrombosis (76%) was comparable with that after DVT (68%) and not improved by anticoagulant therapy. Hormone therapy was the only independent predictor of recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09–4.45; P = .03). Major bleeding was 6.9/100 patient-years. Gastroesophageal varices (HR, 2.63; 95% CI, 1.72–4.03; P < .001) and warfarin therapy (HR, 1.91, 95% CI, 1.25–2.92; P = .003) were independent predictors of bleeding. The 10-year survival rate of patients with splanchnic vein thrombosis (60%) was lower than that of patients with DVT (68%, P < .05). Older age (HR, 1.03; 95% CI, 1.02–1.03), active cancer (HR, 2.23; 95% CI, 1.78–2.78), and myeloproliferative disorder (HR, 1.92; 95% CI, 1.41–2.61) were independent determinants of mortality (P < .001).
Conclusions
Splanchnic vein thrombosis depends on the pathology of the organ supplied. On the basis of the low rate of recurrence and substantial rate of major hemorrhage, prolonged anticoagulant therapy does not appear to be justified.
⁎Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
‡Division of Hematology, Mayo Clinic, Rochester, Minnesota
§Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
Reprint requests Address requests for reprints to: W. E. Wysokinski, MD, Division of Cardiovascular Medicine, Mayo Clinic and Foundation for Education and Research, 200 First Street SW, Rochester, Minnesota 55905. fax: (507) 266-1617
Conflicts of interest The authors disclose no conflicts.
ABSTRACT