Treatment of unusual thrombotic manifestations

Abbattista, Maria; Capecchi, Marco; Martinelli, Ida

doi:10.1182/blood.2019000918

Cited by 22 publications

(34 citation statements)

References 91 publications

(99 reference statements)

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“…In the literature, the results deriving from DOACs use in SVT are based on limited and case studies in the acute SVT. These studies have shown acceptable safety and efficacy profile also in cirrhotic patients 14‐18 . A randomized trial of rivaroxaban versus warfarin was performed for the acute non‐neoplastic portal vein thrombosis showing a remarkable efficacy and safety of the DOACs in the acute hepatitis C virus‐related PVT 19 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Serrao

Merli

Lucani

et al. 2020

Eur J Clin Investigation

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Background Splanchnic vein thrombosis (SVT) is an uncommon but potentially life‐threatening disease usually related to different underlying clinical conditions. The risk of SVT recurrences is high over time in patients with an underlying permanent prothrombotic condition. Vitamin K antagonists (VKA) represent the mainstay of treatment for SVT. Data about the efficacy and safety of direct oral anticoagulants (DOACs) are reported in the literature for the treatment of acute SVT, but less is known about their application for the secondary prophylaxis of venous thromboembolism (VTE). The aim of this study was to assess the efficacy and safety of long‐term DOACs therapy in patients at high‐risk of thrombosis, compared to VKA. Methods This is a retrospective single‐centre study including 70 patients with SVT on long‐term anticoagulant treatment with VKA followed‐up at our Units between January 2017 and December 2019. All the patients were at high thrombotic risk defined as the presence of a permanent prothrombotic condition requiring long‐term anticoagulation. During follow‐up, 28 patients were shifted to DOACs and their clinical outcomes were compared to those of the patients who continued VKA therapy. All the arterial and venous thrombotic events of the splanchnic and extra‐splanchnic districts as well as the haemorrhagic adverse events occurring during follow‐up were recorded. Results Of the seventy patients enrolled in the study, 36 patients (51.4%) had a single‐segment involvement thrombosis (28.5% of portal vein, 7.1% of superior mesenteric vein, 4.3% of splenic vein, 11.5% of hepatic veins) and 34 patients (48.6%) had multi‐segment involvement at the time of diagnosis. 42 patients (60%) continued VKA therapy and 28 (40%) were switched to DOACs. Median follow‐up was 6 years (range 2‐8) during VKA and 1.9 years (range 1‐5.2) during DOACs. The incidence of thrombotic events was similar between patients on VKA and those on DOACs. Patients on VKA developed deep vein thrombosis (DVT), and of the patients on DOACs 1 developed NSTEMI and 1 DVT. No major haemorrhagic events occurred. Minor bleedings occurred in 26% of patients on VKA and in none of the DOACs patients (P: 0.09). Conclusions Our results highlight that DOACs could represent an effective and safe alternative to the VKA for secondary prophylaxis in SVT patients at high risk of thrombosis.

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Section: Discussionmentioning

confidence: 99%

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Serrao

Merli

Lucani

et al. 2020

Eur J Clin Investigation

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“…While a minimum anticoagulant duration of 3 months was suggested, 22 some underlying factors may favor definite (such as unprovoked UEDVT or removed CVC) or indefinite (such as malignancy or persistent CVC) treatment duration. In clinical practice, the majority of patients are usually treated for 3‐6 months and switched to VKAs after the initial heparin treatment, except those with active malignancy 1 …”

Section: Upper Extremity Deep Vein Thrombosismentioning

confidence: 99%

“…Unusual‐site venous thromboembolism (VTE) refers to thrombosis occurring in venous districts outside the veins of the lower limbs and the pulmonary arteries. Examples of atypical locations include abdominal veins (eg, splanchnic, renal, and ovarian), cerebral veins and venous dural sinuses, and the upper extremity venous system 1 …”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants for unusual‐site venous thromboembolism

Riva

Ageno

2021

Research and Practice in Thrombosis and Haemostasis

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Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half‐life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual‐site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual‐site VTE.

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“…53 For instance, in the study by Rottenstreich et al, 52.7% of women with OVT of various etiology received antibiotic therapy and patients with pregnancyrelated OVT were more likely to receive antibiotics than those with non-pregnancy-related OVT (60 vs. 21.4%, p ¼ 0.007). 8 It is nowadays recognized that anticoagulation plays an important role in OVT 53,57,59 ; however, this concept has been debated for several years. There is only one randomized controlled trial, published in 1999, that evaluated the efficacy of heparin in OVT.…”

Section: Hämostaseologiementioning

confidence: 99%

“…8 Expert opinions suggest a definite anticoagulant treatment duration of 3 months for symptomatic postpartum OVT. 53,59 For non-pregnancy-related OVT, some authors 67 suggest to follow the general guidelines for the treatment of usual-site VTE 60 and prescribe anticoagulation for 3 months in patients with transient risk factors (e.g., infection, surgery) and longer duration in patients with persistent risk factors (e.g., cancer, severe thrombophilia). The best treatment strategies for asymptomatic isolated OVT are still debated, including the option of no anticoagulant treatment.…”

Section: Hämostaseologiementioning

confidence: 99%

Ovarian Vein Thrombosis: A Narrative Review

Riva

Calleja‐Agius

2020

Hamostaseologie.

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Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70–80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.

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Treatment of unusual thrombotic manifestations

Cited by 22 publications

References 91 publications

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Direct oral anticoagulants for unusual‐site venous thromboembolism

Ovarian Vein Thrombosis: A Narrative Review

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