Management of incidental splanchnic vein thrombosis in cancer patients

Kreuziger, Lisa Baumann; Ageno, Walter; Lee, Agnes

doi:10.1182/asheducation-2014.1.318

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Similar recurrent VTE, bleeding complications, and mortality rates, comparing incidental PE and deep vein thrombosis (DVT) with symptomatic events has been described [66,67]. However, there is limited evidence about the optimal management of isolated, incidental subsegmental PE and incidental visceral vein thrombosis (iVVT), in particular splanchnic vein thrombosis (SVT) [68]. Some observational retrospective and prospective studies have suggested a similar outcome of incidental subsegmental PE compared to patients with more proximal clots or symptomatic events [67,69], but the precise role of anticoagulation remains unknown in isolated cases.…”

Section: Treatment Of Incidental Thromboembolic Eventsmentioning

confidence: 85%

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019)

et al. 2020

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In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

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Section: Treatment Of Incidental Thromboembolic Eventsmentioning

confidence: 85%

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019)

et al. 2020

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“…In 85% of these patients with nonocclusive PVT, 70% showed spontaneous resolution and 19% showed resolution and reappearance with very few patients having received anticoagulation therapy. When PVT developed prior to progression of the liver disease, it was not statistically associated with increased risk of liver disease progression or decompensation 20. In contrast, an earlier series by Amitrano et al 7 in patients with more advanced cirrhosis reported 11.2% PVT incidence and 45% were symptomatic with portal hypertensive bleed, abdominal pain, and/or intestinal infarction.…”

Section: Risk Factors and Natural Historymentioning

confidence: 85%

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Wu¹,

Schuster²,

Tadros³

2019

Journal of Clinical and Translational Hepatology

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The clinical management of portal vein thrombosis (PVT) remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. The natural history and clinical outcome of PVT are highly variable, dependent upon size, extent and degree of the thrombotic occlusion, as well as the physiological impact of patient comorbidities. While existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT, management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis, factoring in the state of underlying liver disease. In general, patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer management. However, existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying cancer. While low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT, an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in PVT. As such, direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.

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“…Visceral thrombosis is an emergent topic in the literature (50,55,67,68,77,79-83). Due to the heterogeneity of presentation, thrombosis can be discovered incidentally through the course of the disease, in particular in patients with advanced metastatic disease, or thrombosed may present with symptoms that lead to further abdominal imaging.…”

Section: Discussionmentioning

confidence: 99%

“…These uncertainties and the lack of guidelines collectively contribute to challenging decision making in this setting. (50) Currently, most treatment algorithms regarding VT are extrapolated from studies based on patients with liver cirrhosis with/without HCC (13,18,19,51-53), owing to the increased incidence of VT in liver cirrhosis compared to PDAC.…”

Section: Anticoagulationmentioning

confidence: 99%

Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

Hicks

DeRosa

Raj

et al. 2018

Clinical Colorectal Cancer

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Within gastrointestinal malignancies, primary hepatocellular carcinoma and pancreatic ductal adenocarcinoma (PDAC) are frequently associated with visceral thromboses (VT). Thrombus formation in the portal (PVT), mesenteric (MVT), or splenic vein (SVT) system leads to portal hypertension and intestinal ischemia. VT in PDAC may convey a risk of increased distal thrombosis and poses therapeutic uncertainty regarding the role of anticoagulation. An increasing number of reports describe VT associated with PDAC. It is possible that early diagnosis of these events may help reduce morbidity and speculatively improve oncologic outcomes. To perform a systematic review to study PVT, MVT, and SVT associated with PDAC, and to provide a comprehensive review. Medline/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Data Extraction and Assessment: Two blinded independent observers extracted and assessed the studies for diagnosis of PVT, MVT, and SVT in PDAC. Studies were restricted to English-language literature published between 2007 and 2016. Eleven articles were identified. Five case reports and 7 retrospective studies were found, with a total of 127 patients meeting the inclusion criteria. The mean age at diagnosis was 64 years. PVT was found in 35% (n = 46), SVT in 52% (n = 65), and MVT in 13% (n = 15). Mean follow-up time was 26 months. Only 3 of the selected articles studied the impact of anticoagulation in VT. All patients with nonvisceral thrombosis (eg, deep-vein thrombosis, pulmonary emboli) were therapeutically treated; in contrast, patients with VT only rarely received treatment. VT in PDAC is a frequent finding at diagnosis or during disease progression. Evidence to guide treatment choices is limited, and current management is based on inferred experience from nononcologic settings. Anticoagulation appears to be safe in VT, with most of the large studies recommending a careful assessment for patients at a high risk of bleeding.

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Management of incidental splanchnic vein thrombosis in cancer patients

Abstract: A 75-year-old male with metastatic pancreatic cancer is undergoing chemotherapy with gemcitabine.

Cited by 9 publications

References 21 publications

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019)

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019)

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

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