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Splanchnic Vein Thrombosis: Current Perspectives

Authors Valeriani E, Riva N, Di Nisio M, Ageno W

Received 27 June 2019

Accepted for publication 2 October 2019

Published 22 October 2019 Volume 2019:15 Pages 449—461


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Takashi Kajiya

Emanuele Valeriani,1 Nicoletta Riva,2 Marcello Di Nisio,1 Walter Ageno3

1Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy; 2Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; 3Department of Medicine and Surgery, University of Insubria, Varese, Italy

Correspondence: Nicoletta Riva
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta
Tel +356 2545 2518
Fax +356 2545 0000

Abstract: Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.

Keywords: Budd-Chiari syndrome, mesenteric vein thrombosis, portal vein thrombosis, splanchnic vein thrombosis, splenic vein thrombosis

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