Cancer-Associated Splanchnic Vein Thrombosis

Abstract

Splanchnic vein thrombosis (SVT), which includes portal, mesenteric, and splenic vein thrombosis and the Budd–Chiari syndrome, is an infrequent manifestation of venous thromboembolism (VTE). Like typical site VTE, SVT is also frequently associated with cancer, particularly intra-abdominal solid malignancies and myeloproliferative neoplasms (MPNs). The clinical presentation of SVT is nonspecific. Symptoms may be related to the underlying malignancy, and thrombosis is incidentally diagnosed by imaging studies for cancer staging or follow-up in a substantial proportion of cases. The occurrence of SVT predicts worse prognosis in patients with liver or pancreatic cancer and, not uncommonly, SVT may precede the diagnosis of cancer. Therefore, the occurrence of an apparently unprovoked SVT should prompt careful patient evaluation for the presence of an underlying malignancy or MPN. Cancer patients carry a high risk of VTE extension and recurrence and long-term anticoagulant treatment is suggested in the absence of high risk of bleeding. Either LMWH or direct oral anticoagulants (DOACs) are suggested for the treatment of patients with cancer-related SVT, although limited experience is available on the use of DOACs in these settings. Vitamin K antagonists (VKAs) are suggested for the short and long-term treatment of SVT associated with MPN. This review outlines the epidemiological aspects, pathogenesis, risk factors, and diagnosis of cancer-associated SVT, and addresses questions regarding the management of this challenging condition.

Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

“…38 Cancer is a frequent risk factor also for splanchnic vein thrombosis. 39 In a large prospective cohort study of patients with splanchnic vein thrombosis, solid cancer was found in 22.7% and myeloproliferative neoplasms in 8.2% of patients. 40 In addition, the prevalence of solid cancer was higher in patients with incidentally detected compared to symptomatic splanchnic vein thrombosis (35% vs 18%, p<0.0001).…”

Cancer-Associated Abdominal Vein Thrombosis

“…However, a preference is given to LMWH in case of luminal gastrointestinal cancer or genitourinary cancer at high bleeding risk, and in patients receiving chemotherapy which might interact with the DOACs [25]. An indefinite treatment duration is recommended in SVT caused by persistent risk factors, with periodical reassessment of the risk of recurrent VTE and the risk of bleeding [26].…”

Research progress on venous thrombosis development in patients with malignant tumors

“…With demographic shifts and an aging population, the global incidence of tumors has steadily risen, establishing malignant tumors as a leading cause of disease mortality in the 21st century[ 1 - 3 ]. Cancer-associated thrombosis (CAT) stands out as a common complication of malignant tumors, affecting up to approximately 20% of individuals, according to relevant studies[ 4 , 5 ]. The risk of CAT is multifaceted, lacking a singular predictive risk factor or biomarker for its occurrence[ 6 , 7 ].…”