Anticoagulant therapy for splanchnic vein thrombosis: ISTH SSC subcommittee control of anticoagulation

Splanchnic vein thrombosis is an unusual site venous thromboembolism (VTE) which includes portal, mesenteric, or splenic vein thrombosis, and the Budd-Chiari syndrome. The management of splanchnic vein thrombosis remains challenging and often empirical with limited evidence from observational studies and few small randomized trials. The scope of this guidance document is to provide clinicians with practical advice on how to manage splanchnic vein thrombosis, identify patients who may benefit from anticoagulant treatment, and decide on the type and duration of anticoagulation. A systematic search of the literature was performed in MEDLINE and EMBASE databases, and clinical trial registries were searched to retrieve additional information from ongoing studies. Selected articles were critically appraised to formulate guidance statements on relevant clinical questions. The wording “recommend” indicates a strong guidance statement with good consensus among the panelists, whereby the clinician should consider adopting the practice in most cases. The wording “suggest” reflects a weak guidance statement with moderate consensus among the panel members, whereby the clinician may adopt the guidance statement or use an alternative approach to manage patients.