How to treat patients with splanchnic vein thrombosis. recent advances

Splanchnic vein thrombosis (SVT) is an unusual site venous thromboembolism and includes portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome. SVT is a relatively rare disease (portal vein thrombosis and Budd-Chiari syndrome are respectively the most and the least common presentations), roughly a third of cases may be incidentally detected, and liver cirrhosis and solid cancer represent the main risk factors. Once SVT is diagnosed, a careful patient evaluation should be performed to assess the stage, grade, and extension of thrombosis and the risks and benefits of the anticoagulation regimen. Anticoagulant therapy is effective for SVT treatment with high rates of vein recanalization, low rates of thrombosis progression or recurrence and acceptably low rate of bleeding complications. Most available data come from observational studies in patients with liver cirrhosis related SVT receiving low-molecular-weight heparin or vitamin K antagonists. Data on the use of direct oral anticoagulants are increasing and promising. In selected patients and in specialized centers interventional procedures may be considered in adjunction to anticoagulation in cases of mesenteric or extensive SVT, intestinal ischemia, or those whose conditions deteriorate despite adequate anticoagulant therapy. In this narrative review we summarize available evidence on the management of anticoagulation in patients with SVT, identify specific subgroup of patients who may achieve the greatest benefits from anticoagulant therapy, and provide practical advices for clinicians caring for these patients.