Anticoagulant therapy for splanchnic vein thrombosis: an individual patient data meta-analysis
Open accessAbstract
Robust evidence on the optimal management of splanchnic vein thrombosis (SVT) is lacking. We conducted an individual-patient meta-analysis to evaluate the effectiveness and safety of anticoagulation for SVT. Medline, Embase, and clincaltrials.gov were searched up to June 2021 for prospective cohorts or randomized clinical trials including patients with SVT. Data from individual datasets were merged, and any discrepancy with published data was resolved by contacting study authors. Three studies of a total of 1635 patients were included. Eighty-five percent of patients received anticoagulation for a median duration of 316 days (range, 1-730 days). Overall, incidence rates for recurrent venous thromboembolism (VTE), major bleeding, and mortality were 5.3 per 100 patient-years (p-y; 95% confidence interval [CI], 5.1-5.5), 4.4 per 100 p-y (95% CI, 4.2-4.6), and 13.0 per 100 p-y (95% CI, 12.4-13.6), respectively. The incidence rates of all outcomes were lower during anticoagulation and higher after treatment discontinuation or when anticoagulation was not administered. In multivariable analysis, anticoagulant treatment appeared to be associated with a lower risk of recurrent VTE (hazard ratio [HR], 0.42; 95% CI, 0.27-0.64), major bleeding (HR, 0.47; 95% CI, 0.30-0.74), and mortality (HR, 0.23; 95% CI, 0.17-0.31). Results were consistent in patients with cirrhosis, solid cancers, myeloproliferative neoplasms, unprovoked SVT, and SVT associated with transient or persistent nonmalignant risk factors. In patients with SVT, the risk of recurrent VTE and major bleeding is substantial. Anticoagulant treatment is associated with reduced risk of both outcomes.
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In approximately 20-30% of patients with acute mesenteric venous thrombosis, no underlying aetiology or causal factor can be identified.
“In the 20 e 30% of patients in whom the underlying aetiology cannot be identified, AMVT is considered unprovoked or idiopathic.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [212]
Table 1 in Results (Characteristics of the included population; page not provided) reports that 28.3% of the overall splanchnic vein thrombosis cohort was unprovoked. It does not give that percentage specifically for acute mesenteric venous thrombosis; the Discussion also says acute-versus-chronic status was missing for a significant proportion of patients. (LLM, conf=0.88)
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- Authors
- Candeloro, M., Valeriani, E., Monreal, M., Ageno, W., Riva, N., Lopez-Reyes, R., Peris, M. L., Beyer Westendorf, J., Schulman, S., Rosa, V., López-Núñez, J. J., Garcia-Pagan, J.-C., Magaz, M., Senzolo, M., De Gottardi, A., & Di Nisio, M.
- Affiliations
- University of Chieti-Pescara (IT)
- Università Campus Bio-Medico (IT)
- 4Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;
- University of Insubria (IT)
- University of Malta (MT)
- 9Department of Pneumonology, Hospital Universitari i Politècnic La Fe, Valencia, Spain;
- 10Thrombosis Unit, Internal Medicine Service, Consorcio Hospitalario Provincial de Castellón, Universidad CEU Cardenal Herrera, Castellón, Spain;
- 11Department of Medicine, Division of Hematology, Dresden University Hospital, Dresden, Germany;
- Sechenov University (RU)
- Hospital Universitario Virgen de la Arrixaca (ES)
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES)
- 17Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut D’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain;
- Hospital Clínic de Barcelona (ES)
- Azienda Ospedale - Università Padova (IT)
- 20Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland; and
- 21Department of Medicine and Ageing Sciences, “G. D’Annunzio” University, Chieti-Pescara, Italy
- Corresponding author
- Candeloro, Matteo
- ORCID
- Venue
- Blood Advances
- Publisher
- American Society of Hematology
- Published
- 2022-08-04
- Volume
- 6
- Issue
- 15
- Pages
- 4516-4523
- ISSN
- 2473-9529 (ISSN-L)
- 2473-9537
- PMC
- PMC9636325
- OpenAlex
- W4281556916
- Cited by
- 36
- References
- 33
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 12 · 2023: 14 · 2022: 2
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Blood Advances (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc-nd)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc-nd)
- OAR@UM (University of Malta) (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by-nc-nd)
- IrInSubria (University of Insubria) (submittedVersion)
- CEU Repositorio Institucional (Fundación Universitaria San Pablo CEU) (submittedVersion, cc-by-nc-nd)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- splanchnic vein thrombosis, anticoagulation, recurrent venous thromboembolism, major bleeding, mortality, liver cirrhosis, myeloproliferative neoplasms, cancer-associated thrombosis, treatment discontinuation, treatment effectiveness and safety
- MeSH terms
- Anticoagulants, Hemorrhage, Humans, Prospective Studies, Recurrence, Venous Thrombosis, Venous Thromboembolism
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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