Anticoagulant therapy for splanchnic vein thrombosis: a systematic review and meta-analysis

Author:

Valeriani Emanuele12ORCID,Di Nisio Marcello3,Riva Nicoletta4ORCID,Cohen Omri56ORCID,Garcia-Pagan Juan-Carlos7ORCID,Magaz Marta7ORCID,Porreca Ettore1,Ageno Walter8

Affiliation:

1. Department of Medical, Oral, and Biotechnological Sciences, “G. d’Annunzio” University, Chieti-Pescara, Italy;

2. Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy;

3. Department of Medicine and Ageing Sciences, “G. d’Annunzio” Chieti-Pescara, Italy;

4. Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta;

5. National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel;

6. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;

7. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona Spain; and

8. Department of Medicine and Surgery, University of Insubria, Varese, Italy

Abstract

Abstract Treatment of splanchnic vein thrombosis (SVT) is challenging, and evidence to guide therapeutic decisions remains scarce. The objective of this systematic review and meta-analysis was to determine the efficacy and safety of anticoagulant therapy for SVT. MEDLINE, EMBASE, and clinicaltrials.gov were searched from inception through December 2019, without language restrictions, to include observational studies and randomized controlled trials reporting radiological or clinical outcomes in patients with SVT. Pooled proportions and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effects model. Of 4312 records identified by the search, 97 studies including 7969 patients were analyzed. In patients receiving anticoagulation, the rates of SVT recanalization, SVT progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were 58% (95% CI, 51-64), 5% (95% CI, 3-7), 11% (95% CI, 8-15), 9% (95% CI, 7-12), and 11% (95% CI, 9-14), respectively. The corresponding values in patients without anticoagulation were 22% (95% CI, 15-31), 15% (95% CI, 8-27), 14% (95% CI, 9-21), 16% (95% CI, 13-20), and 25% (95% CI, 20-31). Compared with no treatment, anticoagulant therapy obtained higher recanalization (RR, 2.39; 95% CI, 1.66-3.44) and lower thrombosis progression (RR, 0.24; 95% CI, 0.13-0.42), major bleeding (RR, 0.73; 95% CI, 0.58-0.92), and overall mortality (RR, 0.45; 95% CI, 0.33-0.60). These results demonstrate that anticoagulant therapy improves SVT recanalization and reduces the risk of thrombosis progression without increasing major bleeding. The incidence of recurrent VTE remained substantial in patients receiving anticoagulation, as well. Effects were consistent across the different subgroups of patients. This trial was registered on the PROPERO database at (https://www.crd.york.ac.uk/prospero//display_record.php?ID=CRD42019127870) as #CRD42019127870.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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