Splenic vein thrombosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]Sunny Kumar MD [3]
Overview
Medical therapy for splenic vein thrombosis include anticoagulation to maintain INR between 2 to 3. The goal of anticoagulation is to prevent extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop. The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding.
Medical therapy
Medical therapy for splenic vein thrombosis include anticoagulation to maintain INR between 2 to 3. The goal of anticoagulation is to prevent extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop. The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding.[1][2][3][4][5]
- Correction of the causal factors
- Prevention of thrombosis extension
- Achievement of splenic vein patency
- Management of complications related to pancreatitis
- NOTE (1):Initiate anticoagulation with heparin for 3-4 weeks then start oral vitamin K antagonist(e.g. warfarin) to maintain INR between 2 to 3
- Improves recanalization rates
- Decrease development of gastric varices and complications associated with varices
- 2.1 Chronic splenic vein thrombosis
- 2.1.1 Chronic splenic vein thrombosis with hypercoagulable state or previous history of vascular disease
- 2.1.1.1 Long term anticoagulation
- Preferred regimen: Warfarin 2-5 mg PO q24h
- 2.1.1.2 Treatment ofGastric varices
- 2.1.2. Chronic splenic vein thrombosis without hypercoagulable state or previous history of vascular disease
- NOTE: Chronic anticoagulation is generally not recommended
- 2.1.2.1 Treatment of gastric varices
- 2.2 Acute splenic vein thrombosis
- 2.1 Anticoagulant therapy
- 2.1.1 Acute splenic vein thrombosis with hypercoagulable state
- Preferred regimen: Warfarin 2-5 mg PO q24h for long term
- 2.2.2 Acute splenic vein thrombosis without hypercoagulable state
- Preferred regimen: Warfarin 2-5 mg PO q24h for 3-6 months
- 2.2 Thrombolytic therapy
- Preferred regimen: Recombinant tissue plasminogen activator (RTPA)[6]
- Alternate regimen(1): Urokinase[7]
- Alternate regimen(2): Streptokinase[7] The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding
- 2.1 Anticoagulant therapy
References
- ↑ Bouvier A, Gout M, Audia S, Chalumeau C, Rat P, Deballon O (2017). "[Routine screening of splenic or portal vein thrombosis after splenectomy]". Rev Med Interne (in French). 38 (1): 3–7. doi:10.1016/j.revmed.2016.08.003. PMID 27639911.
- ↑ Valla D (2015). "Splanchnic Vein Thrombosis". Semin Thromb Hemost. 41 (5): 494–502. doi:10.1055/s-0035-1550439. PMID 26080307.
- ↑ Gouin B, Robert-Ebadi H, Casini A, Beauverd Y, Fontana P, Righini M; et al. (2017). "[Splanchnic vein thrombosis]". Rev Med Suisse. 13 (586): 2138–2143. PMID 29211374.
- ↑ Riva N, Ageno W (2017). "Approach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis". Vasc Med. 22 (6): 529–540. doi:10.1177/1358863X17734057. PMID 29202678.
- ↑ Riva N, Donadini MP, Dentali F, Squizzato A, Ageno W (2012). "Clinical approach to splanchnic vein thrombosis: risk factors and treatment". Thromb Res. 130 Suppl 1: S1–3. doi:10.1016/j.thromres.2012.08.259. PMID 23026649.
- ↑ Henao EA, Bohannon WT, Silva MB (2003). "Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator". J. Vasc. Surg. 38 (6): 1411–5. doi:10.1016/S0741. PMID 14681650.
- ↑ 7.0 7.1 Tateishi A, Mitsui H, Oki T, Morishita J, Maekawa H, Yahagi N, Maruyama T, Ichinose M, Ohnishi S, Shiratori Y, Minami M, Koutetsu S, Hori N, Watanabe T, Nagawa H, Omata M (2001). "Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation". J. Gastroenterol. Hepatol. 16 (12): 1429–33. PMID 11851847.