ANTICOAGULATION THERAPY AND A CAREFUL INTERDISCIPLINARY MANAGEMENT OF SPLANCHNIC VEIN THROMBOSIS: A SAFE AND EFFECTIVE APPROACH
(Abstract release date: 05/19/16)
EHA Library. Rupoli S. 06/09/16; 133102; E1553
Dr. Serena Rupoli
Contributions
Contributions
Abstract
Abstract: E1553
Type: Eposter Presentation
Background
Splanchnic vein thrombosis (SVT) are unusual thrombosis that may be associated with underlying disorders either local or systemic. The optimal initial treatment of SVT is uncertain and limited data regarding safety and efficacy of anticoagulation are available at present.
Aims
In this report, we present our recent experience with SVT and discuss our treatment algorithm.
Methods
We retrospectively reviewed the records of 38 patients diagnosed as SVT that attended our anticoagulation clinic until June 2015. All clinical, laboratory, therapeutic and outcome data were collected for each patient. In patients who were not actively bleeding, anticoagulation treatment was started as soon as possible according to the platelet count. For a platelet count >50.000/mcl, we administered initial full dose low-molecular-weight heparin (LMWH) and antivitamin-K (AVK; target INR range 2-3 or 1.8-2.5 in the presence of additional risk factors for bleeding), half or prophylactic dose of LMWH for a platelet count between 30.000/mcl and 50.000/mcl and no treatment below 30.000/mcl. Moreover an appropriate prophylaxis with beta-blockers or with endoscopic therapies was extensively employed in in our cohort of cirrhotic SVT. The quality of oral anticoagulation was assessed by the time in therapeutic range (TTR). The response to initial anticoagulant therapy was evaluated as vessel recanalization and computed according to the Kaplan-Meier method. Major bleeding (ISTH definition) and vascular events (arterial and venous thrombosis) were also assessed.
Results
Thirty eight patients were included (median age 51 years; 71.1% males); portal vein thrombosis was the most common site of thrombosis (52.6%), followed by multiple venous segments involvement (34.2%). Hepatic cirrhosis was the common cause (44.7%) while myeloproliferative neoplasms were identified in four patients (10.5%). Thirteen patients (34.2%) were diagnosed incidentally. Thirty five patients (92.1%) were treated with anticoagulation (47.4% with AVK; median TTR 57%). Twenty three patients remained on anticoagulant treatment during the whole study period. During a median treatment duration of 27 months, the incidence rate of vascular events was 2.1 per 100 patient-years (1.6 and 0.8 per 100 patient-years among patients treated with LMWH alone or AVK respectively). Major bleeding occurred in one patient treated with AVK, corresponding to an incidence rate of 0.8 per 100 patient-years. Twenty six patients (68.4%) obtained vessel recanalization or thrombosis resolution. The probability of recanalization of the occluded vessels was 50% at 30 months. The median follow-up was 30.9 months (2-213); four patients (26.7%) died for causes not related to anticoagulation (cirrhosis, cancer).
Conclusion
The use of our treatment algorithm and a careful interdisciplinary management of SVT, appears to be safe and effective even for patients with major risk factors for bleeding (e.g. liver cirrhosis).
Session topic: E-poster
Keyword(s): Anticoagulation, Cirrhosis, Thromboembolism
Type: Eposter Presentation
Background
Splanchnic vein thrombosis (SVT) are unusual thrombosis that may be associated with underlying disorders either local or systemic. The optimal initial treatment of SVT is uncertain and limited data regarding safety and efficacy of anticoagulation are available at present.
Aims
In this report, we present our recent experience with SVT and discuss our treatment algorithm.
Methods
We retrospectively reviewed the records of 38 patients diagnosed as SVT that attended our anticoagulation clinic until June 2015. All clinical, laboratory, therapeutic and outcome data were collected for each patient. In patients who were not actively bleeding, anticoagulation treatment was started as soon as possible according to the platelet count. For a platelet count >50.000/mcl, we administered initial full dose low-molecular-weight heparin (LMWH) and antivitamin-K (AVK; target INR range 2-3 or 1.8-2.5 in the presence of additional risk factors for bleeding), half or prophylactic dose of LMWH for a platelet count between 30.000/mcl and 50.000/mcl and no treatment below 30.000/mcl. Moreover an appropriate prophylaxis with beta-blockers or with endoscopic therapies was extensively employed in in our cohort of cirrhotic SVT. The quality of oral anticoagulation was assessed by the time in therapeutic range (TTR). The response to initial anticoagulant therapy was evaluated as vessel recanalization and computed according to the Kaplan-Meier method. Major bleeding (ISTH definition) and vascular events (arterial and venous thrombosis) were also assessed.
Results
Thirty eight patients were included (median age 51 years; 71.1% males); portal vein thrombosis was the most common site of thrombosis (52.6%), followed by multiple venous segments involvement (34.2%). Hepatic cirrhosis was the common cause (44.7%) while myeloproliferative neoplasms were identified in four patients (10.5%). Thirteen patients (34.2%) were diagnosed incidentally. Thirty five patients (92.1%) were treated with anticoagulation (47.4% with AVK; median TTR 57%). Twenty three patients remained on anticoagulant treatment during the whole study period. During a median treatment duration of 27 months, the incidence rate of vascular events was 2.1 per 100 patient-years (1.6 and 0.8 per 100 patient-years among patients treated with LMWH alone or AVK respectively). Major bleeding occurred in one patient treated with AVK, corresponding to an incidence rate of 0.8 per 100 patient-years. Twenty six patients (68.4%) obtained vessel recanalization or thrombosis resolution. The probability of recanalization of the occluded vessels was 50% at 30 months. The median follow-up was 30.9 months (2-213); four patients (26.7%) died for causes not related to anticoagulation (cirrhosis, cancer).
Conclusion
The use of our treatment algorithm and a careful interdisciplinary management of SVT, appears to be safe and effective even for patients with major risk factors for bleeding (e.g. liver cirrhosis).
Session topic: E-poster
Keyword(s): Anticoagulation, Cirrhosis, Thromboembolism
Abstract: E1553
Type: Eposter Presentation
Background
Splanchnic vein thrombosis (SVT) are unusual thrombosis that may be associated with underlying disorders either local or systemic. The optimal initial treatment of SVT is uncertain and limited data regarding safety and efficacy of anticoagulation are available at present.
Aims
In this report, we present our recent experience with SVT and discuss our treatment algorithm.
Methods
We retrospectively reviewed the records of 38 patients diagnosed as SVT that attended our anticoagulation clinic until June 2015. All clinical, laboratory, therapeutic and outcome data were collected for each patient. In patients who were not actively bleeding, anticoagulation treatment was started as soon as possible according to the platelet count. For a platelet count >50.000/mcl, we administered initial full dose low-molecular-weight heparin (LMWH) and antivitamin-K (AVK; target INR range 2-3 or 1.8-2.5 in the presence of additional risk factors for bleeding), half or prophylactic dose of LMWH for a platelet count between 30.000/mcl and 50.000/mcl and no treatment below 30.000/mcl. Moreover an appropriate prophylaxis with beta-blockers or with endoscopic therapies was extensively employed in in our cohort of cirrhotic SVT. The quality of oral anticoagulation was assessed by the time in therapeutic range (TTR). The response to initial anticoagulant therapy was evaluated as vessel recanalization and computed according to the Kaplan-Meier method. Major bleeding (ISTH definition) and vascular events (arterial and venous thrombosis) were also assessed.
Results
Thirty eight patients were included (median age 51 years; 71.1% males); portal vein thrombosis was the most common site of thrombosis (52.6%), followed by multiple venous segments involvement (34.2%). Hepatic cirrhosis was the common cause (44.7%) while myeloproliferative neoplasms were identified in four patients (10.5%). Thirteen patients (34.2%) were diagnosed incidentally. Thirty five patients (92.1%) were treated with anticoagulation (47.4% with AVK; median TTR 57%). Twenty three patients remained on anticoagulant treatment during the whole study period. During a median treatment duration of 27 months, the incidence rate of vascular events was 2.1 per 100 patient-years (1.6 and 0.8 per 100 patient-years among patients treated with LMWH alone or AVK respectively). Major bleeding occurred in one patient treated with AVK, corresponding to an incidence rate of 0.8 per 100 patient-years. Twenty six patients (68.4%) obtained vessel recanalization or thrombosis resolution. The probability of recanalization of the occluded vessels was 50% at 30 months. The median follow-up was 30.9 months (2-213); four patients (26.7%) died for causes not related to anticoagulation (cirrhosis, cancer).
Conclusion
The use of our treatment algorithm and a careful interdisciplinary management of SVT, appears to be safe and effective even for patients with major risk factors for bleeding (e.g. liver cirrhosis).
Session topic: E-poster
Keyword(s): Anticoagulation, Cirrhosis, Thromboembolism
Type: Eposter Presentation
Background
Splanchnic vein thrombosis (SVT) are unusual thrombosis that may be associated with underlying disorders either local or systemic. The optimal initial treatment of SVT is uncertain and limited data regarding safety and efficacy of anticoagulation are available at present.
Aims
In this report, we present our recent experience with SVT and discuss our treatment algorithm.
Methods
We retrospectively reviewed the records of 38 patients diagnosed as SVT that attended our anticoagulation clinic until June 2015. All clinical, laboratory, therapeutic and outcome data were collected for each patient. In patients who were not actively bleeding, anticoagulation treatment was started as soon as possible according to the platelet count. For a platelet count >50.000/mcl, we administered initial full dose low-molecular-weight heparin (LMWH) and antivitamin-K (AVK; target INR range 2-3 or 1.8-2.5 in the presence of additional risk factors for bleeding), half or prophylactic dose of LMWH for a platelet count between 30.000/mcl and 50.000/mcl and no treatment below 30.000/mcl. Moreover an appropriate prophylaxis with beta-blockers or with endoscopic therapies was extensively employed in in our cohort of cirrhotic SVT. The quality of oral anticoagulation was assessed by the time in therapeutic range (TTR). The response to initial anticoagulant therapy was evaluated as vessel recanalization and computed according to the Kaplan-Meier method. Major bleeding (ISTH definition) and vascular events (arterial and venous thrombosis) were also assessed.
Results
Thirty eight patients were included (median age 51 years; 71.1% males); portal vein thrombosis was the most common site of thrombosis (52.6%), followed by multiple venous segments involvement (34.2%). Hepatic cirrhosis was the common cause (44.7%) while myeloproliferative neoplasms were identified in four patients (10.5%). Thirteen patients (34.2%) were diagnosed incidentally. Thirty five patients (92.1%) were treated with anticoagulation (47.4% with AVK; median TTR 57%). Twenty three patients remained on anticoagulant treatment during the whole study period. During a median treatment duration of 27 months, the incidence rate of vascular events was 2.1 per 100 patient-years (1.6 and 0.8 per 100 patient-years among patients treated with LMWH alone or AVK respectively). Major bleeding occurred in one patient treated with AVK, corresponding to an incidence rate of 0.8 per 100 patient-years. Twenty six patients (68.4%) obtained vessel recanalization or thrombosis resolution. The probability of recanalization of the occluded vessels was 50% at 30 months. The median follow-up was 30.9 months (2-213); four patients (26.7%) died for causes not related to anticoagulation (cirrhosis, cancer).
Conclusion
The use of our treatment algorithm and a careful interdisciplinary management of SVT, appears to be safe and effective even for patients with major risk factors for bleeding (e.g. liver cirrhosis).
Session topic: E-poster
Keyword(s): Anticoagulation, Cirrhosis, Thromboembolism
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