Splanchnic vein thrombosis with and without myeloproliferative neoplasms: a comparative cohort study

Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism but relatively common in patients with myeloproliferative neoplasms (MPNs). Studies on management and outcomes for patients with MPN-SVT, including comparisons with non-MPN-SVT, are scarce.

We assessed anticoagulant management and recurrent thrombosis, bleeding, and survival outcomes in SVT patients with and without MPN.

We conducted a multicenter comparative cohort study in adults with SVT using individual patient data from 3 published studies and 2 hospital cohorts. Anticoagulant management after SVT diagnosis was evaluated; 6-month cumulative incidences of recurrent thrombosis, bleeding, and death were calculated. We used propensity score weighting to compare outcomes between patients with and without MPN. A subanalysis excluding patients with cirrhosis or solid cancer was performed.

We investigated 1189 patients with SVT, 187 with underlying MPN. Anticoagulation was started in 76.1% of patients within 30 days after SVT diagnosis, 78.6% were still anticoagulated at 6 months; this was similar between patients with and without MPN. The 6-month cumulative incidence of recurrent thrombosis and bleeding was 2.5% and 4.5%, respectively. Overall survival was 93.7% at the 6-month follow-up. No significant differences were observed in clinical outcomes between patients with and without MPN, also confirmed by subanalyses.

In this large cohort, incidences of recurrent thrombosis, bleeding and survival 6 months after SVT were similar in patients with and without MPN. This suggests that MPN-related SVT could be regarded similarly to noncirrhotic, nonmalignant SVT for anticoagulant management and outcomes. Prospective studies with long-term follow-up are still needed for MPN-related patients with SVT.