splanchnic vein thrombosis (SVT)
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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]
More general terms
More specific terms
- hepatic vein thrombosis (Budd-Chiari syndrome)
- mesenteric vein thrombosis
- portal vein thrombosis
- renal vein thrombosis
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Sogaard KK et al. Splanchnic venous thrombosis is a marker of cancer and a prognostic factor for cancer survival. Blood 2015 Jun 18 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26089394
- ↑ Jump up to: 2.0 2.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26154791 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1411439
- ↑ Jump up to: 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Jump up to: 4.0 4.1 Yonal I et al The clinical significance of JAK2V617F mutation for Philadelphia-negative chronic myeloproliferative neoplasms in patients with splanchnic vein thrombosis. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22569900
- ↑ Jump up to: 5.0 5.1 5.2 5.3 5.4 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: https://www.ncbi.nlm.nih.gov/pubmed/32619346 https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14836