This protocol addresses symptomatic acute splanchnic vein thrombosis in patients with liver cirrhosis who have not reached adequate vessel recanalization after a first-line anticoagulation course.
Patients with liver cirrhosis presenting with symptomatic acute splanchnic vein thrombosis face the risk of splanchnic hypertension, bleeding complications, and intestinal ischemia. The overriding treatment goal is achieving the highest possible vessel recanalization to reduce these risks.
Initial management in cirrhotic patients involves LMWH, with transition to VKAs or DOACs when not contraindicated by the severity of liver dysfunction. When this anticoagulation regimen does not achieve the highest possible vessel recanalization — the primary therapeutic target — escalation to this protocol is considered.
For very selected patients who meet specific criteria, a thrombolytic approach may be considered — but only at specialized centers. Patient eligibility and the full decision pathway are detailed in the complete protocol.
DOI: 10.1111/jth.14836
In cirrhotic patients with symptomatic acute splanchnic vein thrombosis, we suggest therapeutic dose LMWH, and a switch to VKAs or DOACs if not contraindicated by severity of liver dysfunction.
Treatment of occlusive or non-occlusive acute splanchnic vein thrombosis aims to prevent intestinal infarction or ischemia, and achieve the highest possible vessel recanalization to reduce splanchnic hypertension and bleeding risk.
In patients with symptomatic acute splanchnic vein thrombosis we recommend against the routine use of systemic or catheter-directed thrombolysis. We suggest considering the use of thrombolysis in specialized centers for very selected patients such as those with mesenteric or extensive splanchnic vein thrombosis and signs of intestinal ischemia, or those whose conditions deteriorate despite adequate anticoagulant therapy.
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