Direct oral anticoagulants for the treatment of splanchnic vein thrombosis: A state of art

Abstract

Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease (HD), meconium ileus due to Cystic Fibrosis, etc. The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal constipation, that is far lesser known? Cow’s milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal constipation rather than with bloody stools, diarrhea, and vomiting. The diagnosis and management would be avoidance of cow's milk protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.

Portal Vein Thrombosis: State-of-the-Art Review

“…Portal vein thrombosis (PVT) can be a complication of several pathological conditions, such as chronic liver diseases, local or systemic inflammatory diseases, and neoplasms, among others [ 1 ]. More generally, we refer to the term of splanchnic vein thrombosis (SVT), including thrombosis in the splenic vein, mesenteric vein, portal vein, or hepatic vein (Budd–Chiari syndrome); PVT is the most common site of venous thrombosis [ 1 , 2 ].…”

“…Components of Virchow’s triad (blood flow stasis, vascular damage, and hypercoagulability) combine to produce blood clots that can involve the portal circulation, thus inducing venous thrombosis and portal hypertension. The term PVT broadly indicates thrombosis of the main portal trunk or one of its branches, and it may or may not extend to the splenic or mesenteric vein [ 1 , 2 ]. PVT can develop in a healthy liver or in the context of liver disease, such as cirrhosis.…”