Oktaviana Jesica, Lui Brandon, Ho Prahlad, Lim Hui Y
Northern Clinical Pathology, Thrombosis and Radiology (NECTAR) Research Group (Northern Pathology Victoria), Department of Haematology, Northern Health, Epping.
Australian Centre for Blood Diseases, Monash University, Melbourne.
Blood Coagul Fibrinolysis. 2023 Apr 1;34(3):191-198. doi: 10.1097/MBC.0000000000001213. Epub 2023 Mar 20.
Intra-abdominal venous thromboembolism is rare with heterogeneous management. We aim to evaluate these thrombosis and compare them to deep vein thrombosis and/or pulmonary embolism.
A 10-year retrospective evaluation of consecutive venous thromboembolism presentations (January 2011-December 2020) at Northern Health, Australia, was conducted. A subanalysis of intraabdominal venous thrombosis involving splanchnic, renal and ovarian veins was performed.
There were 3343 episodes including 113 cases of intraabdominal venous thrombosis (3.4%) - 99 splanchnic vein thrombosis, 10 renal vein thrombosis and 4 ovarian vein thrombosis. Of the splanchnic vein thrombosis presentations, 34 patients (35 cases) had known cirrhosis. Patients with cirrhosis were numerically less likely to be anticoagulated compared to noncirrhotic patients (21/35 vs. 47/64, P = 0.17). Noncirrhotic patients ( n = 64) were more likely to have malignancy compared to those with deep vein thrombosis and/or pulmonary embolism (24/64 vs. 543/3230, P < 0.001), including 10 patients diagnosed at time of splanchnic vein thrombosis presentation. Cirrhotic patients reported more recurrent thrombosis/clot progression (6/34) compared to noncirrhotic patients (3/64) (15.6 vs. 2.3 events/100-person-years; hazard ratio 4.7 (95% confidence interval 1.2-18.9), P = 0.030) and other venous thromboembolism patients (2.6/100-person-years; hazard ratio 4.7, 95% confidence interval 2.1-10.7; P < 0.001) with comparable major bleeding rates. All renal vein thrombosis were provoked including five malignant-related cases while three ovarian vein thrombosis occurred postpartum. No recurrent thrombotic or bleeding complications were reported in renal vein thrombosis and ovarian vein thrombosis.
These rare intraabdominal venous thromboses are often provoked. Splanchnic vein thrombosis (SVT) patients with cirrhosis have a higher rate of thrombotic complications, while SVT without cirrhosis was associated with more malignancy. Given the concurrent comorbidities, careful assessment and individualized anticoagulation decision is needed.
腹内静脉血栓栓塞症较为罕见，治疗方法各异。我们旨在评估这些血栓形成情况，并将其与深静脉血栓形成和/或肺栓塞进行比较。
对澳大利亚北部健康中心2011年1月至2020年12月期间连续出现的静脉血栓栓塞病例进行了为期10年的回顾性评估。对涉及内脏、肾和卵巢静脉的腹内静脉血栓形成进行了亚分析。
共有3343例病例，其中113例为腹内静脉血栓形成（3.4%）——99例内脏静脉血栓形成、10例肾静脉血栓形成和4例卵巢静脉血栓形成。在内脏静脉血栓形成病例中，34例患者（35例）已知患有肝硬化。与非肝硬化患者相比，肝硬化患者接受抗凝治疗的可能性在数值上较低（21/35对47/64，P = 0.17）。与深静脉血栓形成和/或肺栓塞患者相比，非肝硬化患者（n = 64）患恶性肿瘤的可能性更高（24/64对543/3230，P < 0.001），其中10例患者在内脏静脉血栓形成时被诊断出患有恶性肿瘤。与非肝硬化患者（3/64）相比，肝硬化患者报告的复发性血栓形成/血栓进展更多（6/34）（15.6对2.3事件/100人年；风险比4.7（95%置信区间1.2 - 18.9），P = 0.030），与其他静脉血栓栓塞患者（2.6/100人年；风险比4.7，95%置信区间2.1 - 10.7；P < 0.001）相比，大出血发生率相当。所有肾静脉血栓形成均为诱因所致，包括5例与恶性肿瘤相关的病例，而3例卵巢静脉血栓形成发生在产后。肾静脉血栓形成和卵巢静脉血栓形成均未报告复发性血栓形成或出血并发症。
这些罕见的腹内静脉血栓形成通常是由诱因引起的。肝硬化的内脏静脉血栓形成（SVT）患者血栓形成并发症发生率较高，而无肝硬化的SVT与更多的恶性肿瘤相关。鉴于并存的合并症，需要进行仔细评估并做出个体化的抗凝决策。
