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Splanchnic vein thrombosis, including Budd-Chiari syndrome and portal vein thrombosis, often stems from myeloproliferative neoplasms. Treatment involves anticoagulation, addressing underlying causes, and managing complications, with varying success in recanalization.

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Area of Science:

  • Vascular Medicine
  • Hepatology
  • Hematology

Background:

  • Splanchnic vein thrombosis encompasses hepatic venous (Budd-Chiari syndrome) and portal venous system thrombosis.
  • Myeloproliferative neoplasms are the leading causal factor for these rare prothrombotic disorders.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for splanchnic vein thrombosis.
  • To discuss the management of Budd-Chiari syndrome and portal vein thrombosis, including their complications and underlying causes.

Main Methods:

  • Diagnosis relies on noninvasive imaging to identify obstruction in the hepatic venous outflow tract.
  • Treatment employs a stepwise approach: anticoagulation, addressing underlying diseases, managing complications, angioplasty/stenting, TIPS, or liver transplantation.
  • Management of portal vein thrombosis focuses on preventing thrombus extension and managing portal hypertension complications.

Main Results:

  • Budd-Chiari syndrome can be managed to prevent a fatal course through a structured therapeutic plan.
  • Early anticoagulation for recent portal vein thrombosis can prevent extension but has limited recanalization success.
  • Chronic portal vein thrombosis management focuses on preventing bleeding from portal hypertension.
  • The role and impact of anticoagulation in patients with cirrhosis and portal vein thrombosis remain uncertain.

Conclusions:

  • A stepwise approach including anticoagulation and specific therapies is crucial for managing Budd-Chiari syndrome.
  • Portal vein thrombosis management requires careful consideration of anticoagulation's benefits and bleeding risks, especially in cirrhosis.
  • Further research is needed to clarify the indications and effects of anticoagulation for portal vein thrombosis in cirrhotic patients.