Recurrent Thrombotic Events after Discontinuation of Vitamin K Antagonist Treatment for Splanchnic Vein Thrombosis: A Multicenter Retrospective Cohort Study.
It is generally recommended that patients with splanchnic vein thrombosis (SVT) should receive a minimum of 3 months of anticoagulant treatment. However, little information is available on the long-term risk of recurrent thrombotic events. The aim of this study was to evaluate the risk of venous and arterial thrombosis after discontinuation of vitamin K antagonist (VKA) in SVT patients. Retrospective information from a cohort of SVT patients treated with VKA and followed by 37 Italian Anticoagulation Clinics, up to June 2013, was collected. Only patients who discontinued VKA and did not receive any other anticoagulant drug were enrolled in this study. Thrombotic events during follow-up were centrally adjudicated. Ninety patients were included: 33 unprovoked SVT, 27 SVT secondary to transient risk factors, and 30 with permanent risk factors. During a median follow-up of 1.6 years, 6 venous and 1 arterial thrombosis were documented, for an incidence of 3.3/100 patient-years (pt-y). The recurrence rate was highest in the first year after VKA discontinuation (8.2/100'pt-y) and in patients with permanent risk factors (10.2/100'pt-y). Liver cirrhosis significantly increased the risk of recurrence. In conclusion, the rate of recurrent vascular complications after SVT is not negligible, at least in some patient subgroups.
Department of Clinical and Experimental Medicine, University of Insubria, 21100 Varese, Italy.
Nicoletta
N
Riva
Department of Clinical and Experimental Medicine, University of Insubria, 21100 Varese, Italy.
Walter
W
Ageno
Department of Heart and Vessels, Thrombosis Centre, AOU Careggi, 50134 Florence, Italy.
Daniela
D
Poli
Haemostasis and Thrombosis Centre, AO Istituti Ospitalieri, 26100 Cremona, Italy.
Sophie
S
Testa
Division of Hematology, Haemostasis and Thrombosis Center, AOU Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, 60020 Ancona, Italy.
Serena
S
Rupoli
Hemophilia Center, Hemostasis and Thrombosis Unit, Azienda Ospedaliera "Pugliese-Ciaccio", 88100 Catanzaro, Italy.
Rita
R
Santoro
Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24100 Bergamo, Italy.
Teresa
T
Lerede
Department of Internal Medicine, Ospedale San Martino, 16100 Genoa, Italy.
Antonietta
A
Piana
Department of Hematology and Transplant Unit, AO San Gerardo, 20900 Monza, Italy.
Monica
M
Carpenedo
Department of Internal Medicine, Arcispedale Santa Maria Nuova, 42100 Reggio Emilia, Italy.
Alberto
A
Nicolini
Dipartimento Emergenza-Urgenza e Area Medica e Specialistica, AOU Parma, 43100 Parma, Italy.
Piera Maria
PM
Ferrini
Spedali Civili di Brescia, 25100 Brescia, Italy.
Giuliana
G
Martini
Ospedale di Galatina, 73013 Galatina, Italy.
Catello
C
Mangione
Dipartimento Onco-Ematologico e Medicina Specialistica, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15100 Alessandria, Italy.
Laura
L
Contino
Department of Transfusion Medicine and Haematology, Carlo Poma Hospital, 46100 Mantua, Italy.
Carlo
C
Bonfanti
Department of Internal Medicine, University of Perugia, 06126 Perugia, Italy.
Paolo
P
Gresele
Department of Hematology, Hemostasis and Thrombosis Center, S. Bortolo Hospital, 36100 Vicenza, Italy.
Alberto
A
Tosetto