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

Autor: Alessandra Serrao, Francesca Aprile, Benedetta Lucani, Stefania Gioia, Manuela Merli, Massimo Breccia, Luciano Fiori, Olivero Riggio, Antonio Chistolini
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Pyridines
Pyridones
Deep vein
Clinical Biochemistry
Hemorrhage
Budd-Chiari Syndrome
030204 cardiovascular system & hematology
Biochemistry
anticoagulant treatment
03 medical and health sciences
0302 clinical medicine
Rivaroxaban
Internal medicine
Secondary Prevention
anticoagulant treatment
splanchnic venous thrombosis
Humans
Medicine
030212 general & internal medicine
Superior mesenteric vein
Adverse effect
Venous Thrombosis
Duration of Therapy
Portal Vein
business.industry
Acenocoumarol
Incidence (epidemiology)
Anticoagulants
General Medicine
Middle Aged
medicine.disease
Thrombosis
Thiazoles
Venous thrombosis
medicine.anatomical_structure
Splanchnic vein thrombosis
Splenic vein
Mesenteric Ischemia
Pyrazoles
Female
Warfarin
business
splanchnic venous thrombosis
Factor Xa Inhibitors
Zdroj: European Journal of Clinical Investigation. 51
ISSN: 1365-2362
0014-2972
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: