Rivaroxaban Prophylaxis in Noncirrhotic Portal Vein Thrombosis

Plessier, Aurélie; Goria, Odile; Cervoni, Jean Paul; Ollivier, Isabelle; Bureau, Christophe; Poujol-Robert, Armelle; Minello, Anne; Houssel‐Debry, Pauline; Rautou, P.-E.; Payancé, Audrey; Scoazec, Giovanna; Bruno, Onorina; Corbic, Michèle; Durand, François; Vilgrain, Valérie; Paradis, Valérie; Boudaoud, L.; Raucourt, Emmanuelle de; Roy, Carine; Gault, Nathalie; Valla, Dominique

doi:10.1056/evidoa2200104

Cited by 18 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall survival of PV patients in the study 138 was not affected by SVT; furthermore, there was little evidence of disease progression in patients with MPN‐U with SVT ( n = 55). The potential value of systemic anticoagulation in SVT, in the setting of noncirrhotic chronic portal vein thrombosis, was recently underlined in a controlled study of 111 patients where the recurrent thrombosis rate was 0 per 100 person‐years in patients treated with rivaroxaban versus 19.71 per 100 person‐years in those not receiving such treatment; after a median follow‐up of 30.3 months, major bleeding occurred in two patients receiving rivaroxaban and in one patient not receiving anticoagulation 170 …”

Section: Treatmentmentioning

confidence: 99%

Polycythemia vera: 2024 update on diagnosis, risk‐stratification, and management

Tefferi

Barbui

2023

American J Hematol

View full text Add to dashboard Cite

Disease Overview Polycythemia vera (PV) is a JAK2‐mutated myeloproliferative neoplasm characterized by clonal erythrocytosis; other features include leukocytosis, thrombocytosis, splenomegaly, pruritus, constitutional symptoms, microcirculatory disturbances, and increased risk of thrombosis and progression into myelofibrosis (post‐PV MF) or acute myeloid leukemia (AML). Diagnosis A working diagnosis is considered in the presence of a JAK2 mutation associated with hemoglobin/hematocrit levels of >16.5 g/dL/49% in men or 16 g/dL/48% in women; morphologic confirmation by bone marrow examination is advised but not mandated. Cytogenetics Abnormal karyotype is seen in 15%–20% of patients with the most frequent sole abnormalities being +9 (5%), loss of chromosome Y (4%), +8 (3%), and 20q− (3%). Mutations Over 50% of patients harbor DNA sequence variants/mutations other than JAK2, with the most frequent being TET2 (18%) and ASXL1 (15%). Prognostically adverse mutations include SRSF2, IDH2, RUNX1, and U2AF1, with a combined incidence of 5%–10%. Survival and Prognosis Median survival is ⁓15 years but exceeds 35 years for patients aged ≤40 years. Risk factors for survival include older age, leukocytosis, abnormal karyotype, and the presence of adverse mutations. Twenty‐year risk for thrombosis, post‐PV MF, or AML are ⁓26%, 16% and 4%, respectively. Risk Factors for Thrombosis Two risk categories are considered: high (age >60 years or thrombosis history) and low (absence of both risk factors). Additional predictors for arterial thrombosis include cardiovascular risk factors and for venous thrombosis higher absolute neutrophil count and JAK2V617F allele burden. Treatment Current goal of therapy is to prevent thrombosis. Periodic phlebotomy, with a hematocrit target of <45%, combined with once‐ or twice‐daily aspirin (81 mg) therapy, absent contraindications, is the backbone of treatment in all patients, regardless of risk category. Cytoreductive therapy is reserved for high‐risk disease with first‐line drugs of choice being hydroxyurea and pegylated interferon‐α and second‐line busulfan and ruxolitinib. In addition, systemic anticoagulation is advised in patients with venous thrombosis history. Additional Treatment Considerations At the present time, we do not consider a drug‐induced reduction in JAK2V617F allele burden, which is often incomplete and seen not only with peg‐IFN but also with ruxolitinib and busulfan, as an indicator of disease‐modifying activity, unless accompanied by cytogenetic and independently‐verified morphologic remission. Accordingly, we do not use the specific parameter to influence treatment choices. The current review also includes specific treatment strategies in the context of pregnancy, splanchnic vein thrombosis, pruritus, perioperative care, and post‐PV MF.

show abstract

Section: Treatmentmentioning

confidence: 99%

Polycythemia vera: 2024 update on diagnosis, risk‐stratification, and management

Tefferi

Barbui

2023

American J Hematol

View full text Add to dashboard Cite

show abstract

“…A very recent randomized study provided clear evidence for a beneficial effect of DOAC in patients with noncirrhotic PVT versus no anticoagulation. In this study of patients with chronic PVT without major risk factors for thrombosis, rivaroxaban reduced the incidence of venous thromboembolism and did not increase the number of major bleeding events 50 . Although this has to be confirmed in patients with underlying MPN, it provides first strong evidence for the safety and efficacy of rivaroxaban in the context of SVT.…”

Section: Introductionmentioning

confidence: 63%

“…In this study of patients with chronic PVT without major risk factors for thrombosis, rivaroxaban reduced the incidence of venous thromboembolism and did not increase the number of major bleeding events. 50 Although this has to be confirmed in patients with underlying MPN, it provides first strong evidence for the safety and efficacy of rivaroxaban in the context of SVT. Although the combination of aspirin and anticoagulation may be the best treatment to avoid recurrence of venous thromboembolism in patients with MPN, 51 the role of antiplatelet therapy in patients with SVT is less clear since it may be associated with an increased risk of bleeding events, especially those related to portal hypertension, such as variceal or gastric bleeding.…”

Section: Treatment Of Mpn In the Context Of Svtmentioning

confidence: 95%

Myeloproliferative neoplasms and splanchnic vein thrombosis: Contemporary diagnostic and therapeutic strategies

Kiladjian

Cassinat

2023

American J Hematol

View full text Add to dashboard Cite

Myeloproliferative neoplasms (MPNs) are the most common etiologies of primary splanchnic vein thrombosis, present in almost forty percent of patients with Budd‐Chiari syndrome or portal vein thrombosis. Diagnosis of MPNs can be difficult in these patients because key characteristics, such as elevated blood cell counts and splenomegaly, are confounded by portal hypertension or bleeding complications. In recent years, diagnostic tools have improved to provide more accurate diagnosis and classification of MPNs. Although bone marrow biopsy findings remain a major diagnostic criterion, molecular markers are playing an increasing role not only in diagnosis but also in better estimating prognosis. Therefore, though screening for JAK2V617F mutation should be the starting point of the diagnostic workup performed in all patients with splanchnic vein thrombosis, a multidisciplinary approach is needed to accurately diagnose the subtype of myeloproliferative neoplasm, recommend the useful additional tests (bone marrow biopsy, search for an additional mutation using targeted next‐generation sequencing), and suggest the best treatment strategy. Indeed, providing a specific expert care pathway for patients with splanchnic vein thrombosis and underlying myeloproliferative neoplasm is crucial to determine the optimal management to reduce the risk of both hematological and hepatic complications.

show abstract

“…Recently, the RIPORT study enrolled 111 patients with noncirrhotic chronic PVT, without major thrombotic risk factors. 115 They were randomly assigned to rivaroxaban 15 mg once daily or no anticoagulant treatment. An interim analysis (median follow-up of 11.8 months) highlighted that none of the patients in the DOAC group developed VTE, while the incidence was 19.7 per 100 person-years in the control group.…”

Section: Anticoagulant Treatment In Special Categories Of Patientsmentioning

confidence: 99%

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment

Custo,

Tabone,

Aquilina

et al. 2024

Hamostaseologie

View full text Add to dashboard Cite

Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism occurring within the splanchnic venous system. Portal vein thrombosis is the most common presentation, while Budd–Chiari syndrome is the least common. Liver cirrhosis and abdominal solid cancer are the main local risk factors for SVT, whereas myeloproliferative neoplasms are the predominant systemic risk factors. Signs and symptoms of SVT are nonspecific and include abdominal pain, gastrointestinal bleeding, and ascites. Asymptomatic SVT is not uncommon, and the majority would be detected incidentally on routine abdominal imaging performed for the follow-up of liver diseases and tumors. The management of SVT aims to prevent thrombus progression, promote vessel recanalization, and prevent recurrent venous thromboembolism. Anticoagulation should be started early in order to increase the chances of vessel recanalization and reduce the risk of portal hypertension-related complications. Direct oral anticoagulants have been included in recent guidelines, as alternatives to vitamin K antagonists, after clinical stability has been reached; however, caution is required in patients with liver or kidney dysfunction. Treatment duration is based on the presence (or absence) and type (transient vs. permanent) of risk factors. This narrative review aims to summarize the latest evidence on SVT, with a particular focus on the anticoagulant treatment in special categories of patients (e.g., liver cirrhosis, solid cancer, myeloproliferative neoplasms, pancreatitis, incidentally detected SVT, Budd–Chiari syndrome, and chronic SVT).

show abstract

Rivaroxaban Prophylaxis in Noncirrhotic Portal Vein Thrombosis

Cited by 18 publications

References 49 publications

Polycythemia vera: 2024 update on diagnosis, risk‐stratification, and management

Polycythemia vera: 2024 update on diagnosis, risk‐stratification, and management

Myeloproliferative neoplasms and splanchnic vein thrombosis: Contemporary diagnostic and therapeutic strategies

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment

Contact Info

Product

Resources

About