Cancer-Associated Splanchnic Vein Thrombosis

Area of Science:

• Oncology
• Hematology
• Vascular Medicine

Background:

• Splanchnic vein thrombosis (SVT), encompassing portal, mesenteric, splenic vein thrombosis, and Budd-Chiari syndrome, is an uncommon form of venous thromboembolism (VTE).
• SVT frequently co-occurs with malignancies, especially intra-abdominal cancers and myeloproliferative neoplasms (MPNs).
• Clinical presentation of SVT is often nonspecific, with incidental diagnosis during cancer staging or follow-up being common.

Purpose of the Study:

• To review the epidemiology, pathogenesis, risk factors, and diagnosis of cancer-associated SVT.
• To discuss management strategies for SVT in cancer patients and those with MPNs.

Main Methods:

• Literature review focusing on epidemiological data, risk factors, diagnostic approaches, and treatment modalities for SVT.
• Analysis of existing guidelines and clinical experiences regarding anticoagulation in cancer-associated SVT and MPN-associated SVT.

Main Results:

• SVT occurrence predicts a poorer prognosis in liver and pancreatic cancer patients and can precede cancer diagnosis.
• Cancer patients with SVT have a high risk of VTE extension and recurrence, necessitating long-term anticoagulation if bleeding risk is low.
• Low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) are recommended for cancer-related SVT, while Vitamin K antagonists (VKAs) are suggested for MPN-associated SVT.

Conclusions:

• Unprovoked SVT warrants thorough evaluation for underlying malignancy or MPN.
• Management of cancer-associated SVT requires careful consideration of anticoagulation, balancing efficacy with bleeding risk.
• Further research is needed, particularly on DOACs for cancer-related SVT.