Incidence and factors predictive of recurrent thrombosis in people with non-cirrhotic portal vein thrombosis

• Published in: Journal of hepatology Vol. 78; no. 1; pp. 114 - 122
• Main Authors: Baiges, Anna, Procopet, Bogdan, Silva-Junior, Gilberto, Llop, Elba, Tellez, Luis, Darnell, Anna, Garcia-Criado, Ángeles, Turon, Fanny, Nicoara-Farcau, Oana, González-Alayón, Carlos, Larrue, Hélène, Magaz, Marta, Olivas, Pol, Perez-Campuzano, Valeria, Calleja, Jose Luis, Albillos, Agustin, Reverter, Juan Carlos, Bureau, Christophe, Bosch, Jaime, Hernández-Gea, Virginia, Garcia-Pagán, Juan Carlos
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-01-2023
• Subjects: Anticoagulants - therapeutic use; Coagulation; Extrasplanchnic thrombotic event; Factor VIII; Humans; Imaging follow-up; Incidence; Liver Diseases - drug therapy; Long-term anticoagulation; Portal Vein; Re-thrombosis; Splanchnic Circulation; Thrombophilia - epidemiology; Thrombophilia - etiology; Venous Thrombosis - diagnosis; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; Long-term anticoagulation; Imaging follow-up; Coagulation; Factor VIII; Re-thrombosis; Extrasplanchnic thrombotic event
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2022.08.023

Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that there is a very low risk of recurrent thrombosis (RT). Our first aim was to describe the incidence of RT in people with NC-SVT without an indication for long-term anticoagulation. The second aim was to identify RT risk factors and afterwards verify them in a validation cohort.
This is a multicentre, retrospective observational study evaluating risk factors for RT in 64 people with NC-SVT of idiopathic/local factor aetiology. In a subgroup of 48 individuals, the potential value of additional thrombophilic parameters to predict RT was analysed. Findings were validated in 70 individuals with idiopathic/local factor NC-SVT.
Of the 64 participants in the training cohort, 17 (26%) presented splanchnic and/or extrasplanchnic RT (overall-RT) during follow-up (cumulative incidence: 2, 10, 19, and 34% at 1, 2, 5, and 10 years, respectively). In addition, 53% of people with splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 people with an additional comprehensive thrombophilic study, factor VIII ≥150% was the only independent factor predicting overall-RT (hazard ratio 7.10, 95% CI 2.17–23.17, p <0.01). In the validation cohort, 19 individuals (27%) presented overall-RT, and it was also independently predicted by factor VIII >150% (hazard ratio 3.71, 95% CI 1.31–10.5, p <0.01). The predictive value of factor VIII was confirmed in both people with idiopathic/local factor aetiology associated NC-SVT.
People with idiopathic/local factor NC-SVT are at risk of overall-RT. Splanchnic RT can be asymptomatic and requires screening for its detection. Values of factor VIII ≥150% may help identify individuals at high risk of overall-RT who could benefit from long-term anticoagulation.
People with idiopathic/isolated local factor non-cirrhotic portal vein thrombosis were previously thought to be at minimal risk of re-thrombosis and therefore did not receive scheduled follow-up. The results of this study are of special interest for hepatologists treating people with non-cirrhotic splanchnic thrombosis, as they show a 25% incidence of re-thrombosis and support the close follow-up of people with factor VIII >150% to ensure the early identification of new thrombotic events.
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•Individuals with non-cirrhotic splanchnic thrombosis without thrombophilia are at risk of re-thrombosis.•Splanchnic re-thrombosis can be asymptomatic and requires screening for its detection.•Factor VIII ≥150% may help identify individuals at higher risk of re-thrombosis.