Mesenteric venous thrombosis is a rare lethal disease. The main aim of the present study was to evaluate clinical efficacy and safety of direct oral anticoagulants and vitamin K antagonists in mesenteric venous thrombosis patients.
Methods
Retrospective study of 102 mesenteric venous thrombosis patients treated between 2004 and 2017 at a center with a conservative medical first approach. Median clinical follow-up was 4 years.
Results
Computed tomography showed successful recanalization of thrombosis in 71% of patients on vitamin K antagonists and 69% of patients on direct oral anticoagulants (p = 0.88). Overall major and esophageal variceal bleeding rate was 14.7% and 2.9%, respectively. No difference in major bleeding (p = 0.54) was found between vitamin K antagonists and direct oral anticoagulants. No mesenteric venous thrombosis recurrence occurred during follow-up, and one venous thromboembolism occurred after cessation of anticoagulation.
Conclusion
Anticoagulation with direct oral anticoagulants and vitamin K antagonists was efficient in patients with mesenteric venous thrombosis. Bleeding complications was a concern during treatment in both groups.
BjörckMKoelemayMAcostaSet al.Editor's choice – Management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg2017; 53: 460–510.
2.
ZarroukMSalimSElfJet al.Testing for thrombophilia in mesenteric venous thrombosis – retrospective original study and systematic review. Best Pract Res Clin Gastroenterol2017; 31: 39–48.
3.
HagspielKDFlorsLHanleyMet al.Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol2015; 18: 2–13.
MaanAPadmanabhanRShaikhAYet al.Newer anticoagulants in cardiovascular disease: a systematic review of the literature. Cardiol Rev2012; 20: 209–221.
8.
KearonCAklEAOrnelasJet al.Antithrombotic therapy for VTE disease. CHEST Guideline and Expert Panel Report. Chest2016; 149: 315–352.
9.
AgenoWBeyer-WestendorfJGarciaDet al.Guidance for the management of venous thrombosis in unusual sites. J Thromb Thrombolysis2016; 4: 129–143.
10.
SchulmanSKearonCKakkarAKet al.RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med2009; 361: 2342–2352.
11.
BauersachsRBerkowitzSDBrennerBet al.Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med2010; 363: 2499–2510.
12.
Hokusai-VTE InvestigatorsBüllerHRDecoususHGrossoMAet al.Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med2013; 369: 1406–1415.
13.
AgnelliGBullerHRCohenAet al.AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med2013; 369: 799–808.
14.
EINSTEIN-EP InvestigatorsBullerHRPrinsMHet al.Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med2012; 366: 1287–1297.
15.
WielochMSjälanderAFrykmanVet al.Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA. Eur Heart J2011; 32: 2282–2289.
16.
SchulmanSAngerasUBergqvistDet al.Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost2010; 8: 202–204.
17.
GrubbANymanUBjörkJet al.Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan–Barratt prediction equations for children. Clin Chem2005; 51: 1420–1431.
18.
AcostaSAlhadadAEkbergO. Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis. Emerg Radiol2009; 16: 477–482.
19.
BjörckFSandénPRenlundHet al.Warfarin treatment quality is consistently high in both anticoagulation clinics and primary care setting in Sweden. Thromb Res2015; 136: 216–220.
20.
De StefanoVVannucchiAMRuggeriMet al.Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J2016; 6: e493.
21.
DentaliFAgenoWWittDet al.Natural history of mesenteric venous thrombosis in patients treated with vitamin K antagonists. A multi-centre, retrospective cohort study. Thromb Haemost2009; 102: 501–504.
22.
AgenoWDentaliFSquizzatoA. How I treat splanchnic vein thrombosis. Blood2014; 124: 3685–3691.
23.
Nagaoki Y, Aikata H, Daijyo K, et al. Efficacy and safety of edoxaban for treatment of portal vein thrombosis following danaparoid sodium in patients with liver cirrhosis. Hepatol Res. Epub ahead of print 24 March 2017. DOI: 10.1111/hepr.12895.
24.
YatesSGSarodeR. New strategies for effective treatment of vitamin K antagonist-associated bleeding. J Thromb Haemostat2015; 13(Suppl 1): S180–S186.
25.
PollackCVJrReillyPAEikelboomJet al.Idarucizumab for dabigatran reversal. N Engl J Med2015; 373: 511–520.
26.
AklEAKahaleLBarbaMet al.Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev2014; 7: CD006650.
27.
ConnorsJM. Thrombophilia testing and venous thrombosis. N Engl J Med2017; 377: 1177–1187.
28.
LymanGHBohlkeKKhoranaAAet al.Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol2015; 33: 654–656.
29.
RaskobGEvan EsNBlekerSMet al.Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med2018; 378: 615–624.
