title: Long-term Clinical Outcomes of Splanchnic Vein Thrombosis: Results of an International Registry.
abstract: OBJECTIVE
  Little information is available on the long-term clinical outcome of patients with splanchnic vein thrombosis (SVT).
  
  
  OBJECTIVE
  To assess the incidence rates of bleeding, thrombotic events, and mortality in a large international cohort of patients with SVT.
  
  
  METHODS
  A prospective cohort study was conducted beginning May 2, 2008, and completed January 30, 2014, at hospital-based centers specialized in the management of thromboembolic disorders; a 2-year follow-up period was completed January 30, 2014, and data analysis was conducted from July 1, 2014, to February 28, 2015. Participants included 604 consecutive patients with objectively diagnosed SVT; there were no exclusion critieria. Information was gathered on baseline characteristics, risk factors, and antithrombotic treatment. Clinical outcomes during the follow-up period were documented and reviewed by a central adjudication committee.
  
  
  METHODS
  Major bleeding, defined according to the International Society on Thrombosis and Hemostasis; bleeding requiring hospitalization; thrombotic events, including venous and arterial thrombosis; and all-cause mortality.
  
  
  RESULTS
  Of the 604 patients (median age, 54 years; 62.6% males), 21 (3.5%) did not complete follow-up. The most common risk factors for SVT were liver cirrhosis (167 of 600 patients [27.8%]) and solid cancer (136 of 600 [22.7%]); the most common sites of thrombosis were the portal vein (465 of 604 [77.0%]) and the mesenteric veins (266 of 604 [44.0%]). Anticoagulation was administered to 465 patients in the entire cohort (77.0%) with a mean duration of 13.9 months; 175 of the anticoagulant group (37.6%) received parenteral treatment only, and 290 patients (62.4%) were receiving vitamin K antagonists. The incidence rates (reported with 95% CIs) were 3.8 per 100 patient-years (2.7-5.2) for major bleeding, 7.3 per 100 patient-years (5.8-9.3) for thrombotic events, and 10.3 per 100 patient-years (8.5-12.5) for all-cause mortality. During anticoagulant treatment, these rates were 3.9 per 100 patient-years (2.6-6.0) for major bleeding and 5.6 per 100 patient-years (3.9-8.0) for thrombotic events. After treatment discontinuation, rates were 1.0 per 100 patient-years (0.3-4.2) and 10.5 per 100 patient-years (6.8-16.3), respectively. The highest rates of major bleeding and thrombotic events during the whole study period were observed in patients with cirrhosis (10.0 per 100 patient-years [6.6-15.1] and 11.3 per 100 patient-years [7.7-16.8], respectively); the lowest rates were in patients with SVT secondary to transient risk factors (0.5 per 100 patient-years [0.1-3.7] and 3.2 per 100 patient-years [1.4-7.0], respectively).
  
  
  CONCLUSIONS
  Most patients with SVT have a substantial long-term risk of thrombotic events. In patients with cirrhosis, this risk must be balanced against a similarly high risk of major bleeding. Anticoagulant treatment appears to be safe and effective in most patients with SVT.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Riva
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital "Carl Gustav Carus," Dresden, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
authors.affiliation: Department of Internal Medicine, Seoul National University, Seoul, South Korea.
authors.forename: Soo Mee
authors.initials: SM
authors.lastname: Bang
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, University Hospital of Padova, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Grandone
authors.affiliation: Center for Hemorrhagic and Thrombotic Diseases, University Hospital, Udine, Italy.
authors.forename: Samantha
authors.initials: S
authors.lastname: Pasca
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy9Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, Milan, Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.affiliation: Thrombosis Center, Galliera Hospital, Genoa, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Duce
authors.affiliation: Department of Hematology, Policlinico Universitario di Palermo, Palermo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Malato
authors.affiliation: Haemophilia Center, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Santoro
authors.affiliation: Thrombosis Center, Careggi Hospital, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.affiliation: Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Martinelli
authors.affiliation: Department of Vascular Medicine, University of Groningen, Groningen, the Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Kamphuisen
authors.affiliation: Department of Internal Medicine, Pochon CHA University, Seoul, Korea.
authors.forename: Doyeun
authors.initials: D
authors.lastname: Oh
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Elbio
authors.initials: E
authors.lastname: D'Amico
authors.affiliation: Department of Internal and Vascular Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Institute of Hematology, Catholic University, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: De Stefano
authors.affiliation: Department of Clinical Medicine, University Hospital of Sassari, Sassari, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Vidili
authors.affiliation: Unità Operativa Semplice Dipartimentale di Ematologia e Malattie Trombotiche, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vaccarino
authors.affiliation: Department of Medicine I, Busto Arsizio Hospital, Busto Arsizio, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nardo
authors.affiliation: Department of Medical, Oral, and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D013152:Splanchnic Circulation; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D000925:Anticoagulants