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

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; ... (2023). Incidence and factors predictive of recurrent thrombosis in patients with non-cirrhotic portal vein thrombosis. Journal of hepatology, 78(1), pp. 114-122. Elsevier 10.1016/j.jhep.2022.08.023

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BACKGROUND AND AIMS

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 patients with NC-SVT without indication for long-term anticoagulation. The second aim was to identify RT risk factors and afterwards verify them in a validation cohort.

METHODS

Multicenter retrospective observational study evaluating risk factors for RT in 64 patients with NC-SVT of idiopathic/local etiology. In a subgroup of 48 patients the potential value of additional thrombophilic parameters to predict RT was analyzed. Findings were validated in 70 independent patients with idiopathic/local NC-SVT.

RESULTS

Of the 64 patients, 17 (26%) presented splanchnic and/or extra-splanchnic RT (overall-RT) during follow-up (cumulative incidence: 2%, 10%, 19% and 34% at 1, 2, 5 and 10 years). 53% of splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 patients with additional comprehensive thrombophilic study, factor VIII ≥ 150% was the only independent factor predicting overall-RT (HR 7.10 (CI 2.17 - 23.17) p< 0.01). In the validation cohort 19 patients (27%) presented overall-RT, and it was also independently predicted by factor VIII > 150% (HR 3.71 (1.31 - 10.5), p < 0.01). The predictive value of factor VIII was confirmed both in patients with idiopathic and with local etiology.

CONCLUSIONS

Patients with idiopathic/local 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 patients at high risk of overall-RT who could benefit from long-term anticoagulation.

LAY SUMMARY

Patients with idiopathic/isolated local factor non cirrhotic splanchnic vein thrombosis (NC-SVT) were previously thought to be at minimal risk of rethrombosis. Our results show a 25% incidence of rethrombosis and support the indication of close follow-up to identify new thrombotic events, specially in patients with factor VIII >150%.

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