DOACs Show Promise in Treating Splanchnic Vein Thrombosis

Splanchnic vein thrombosis (SVT), an uncommon type of venous thromboembolism affecting the splanchnic venous system, has posed challenges in terms of its management due to limited evidence. However, a recent comprehensive review and meta-analysis published in Thrombosis Research by Allen Li and colleagues have shed new light on the efficacy and safety of treatment options, particularly focusing on direct oral anticoagulants (DOACs).

The study's primary goal was to assess the effectiveness and safety of DOACs in comparison to low-molecular-weight heparins (LMWHs), vitamin K antagonists (VKAs), or no anticoagulation treatment for SVT.

● DOACs emerged as a promising treatment option. In non-cirrhotic patients, DOACs displayed superior efficacy compared to VKAs, achieving a significant complete recanalization of affected vessels (OR = 4.33; 95% CI: 2.4, 7.83).

● In cirrhotic patients, DOACs were also more effective than no anticoagulation treatment (OR = 3.86; 95% CI: 1.49, 10.03).

● One of the most remarkable findings was the reduced risk of major bleeding associated with DOACs. Non-cirrhotic patients on DOACs experienced significantly less major bleeding compared to those on observation, LMWHs, and VKAs (OR = 0.09; 95% CI: 0.03, 0.29).

● DOACs did not show a significant difference in major bleeding when compared to observation, LMWHs, or VKAs in cirrhotic patients.

The study's results suggest that DOACs could be a favourable alternative to traditional treatments like VKAs and LMWHs for non-cirrhotic patients with SVT. However, further research is needed, including larger studies that account for various SVT causes, patient risk factors, and overall bleeding risks.

This breakthrough research not only provides valuable insights into the management of SVT but also opens doors for potential advancements in the treatment of this condition. As medical experts delve deeper into the intricacies of SVT and its treatment options, patient care could see significant improvements, ultimately enhancing the quality of life for those affected.

Reference:

Li, A., Zhang, M. C., Li, P., Eshaghpour, A., Li, K., Carrier, M., Wells, P., & Crowther, M. A. (2023). Direct oral anticoagulants for the treatment of splanchnic vein thrombosis – A systematic review and meta-analysis. Thrombosis Research, 229, 209–218. https://doi.org/10.1016/j.thromres.2023.06.003