OC 48.3 - Direct Oral Anticoagulants for the Treatment of Splanchnic Vein Thrombosis: A Systematic Review and Meta-Analysis

Monday, July 11, 2022

3:15 PM – 3:30 PM

Location: ExCel Center, ICC Capital Suite Room 17

Presentation Format: In-Person

Presenting Author(s)

Allen Li

Research Appointee
McMaster University, Department of Medicine
Ottawa, Ontario, Canada

Co-Author(s)

Pei Ye Li

Medical Student
Temerty Faculty of Medicine, University of Toronto
Toronto, Ontario, Canada
MZ

Ming Chan Zhang

Medical Student
Michael G. DeGroote School of Medicine
Hamilton, Ontario, Canada
AE

Ali Eshaghpour

Resident Physician
Department of Medicine, McMaster University
Hamilton, Ontario, Canada
Marc Carrier, MD

MD, MSc
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
MC

Mark Crowther, MD MSc

Professor
Department of Medicine, McMaster University
Hamilton, Ontario, Canada

Background: Splanchnic vein thrombosis (SVT) is a form of atypical venous thrombosis (VTE) that occurs in the hepatic portal veins, mesenteric veins, splenic veins, and hepatic veins (Budd-Chiari Syndrome, BCS). Current guidelines suggest the use of direct oral anticoagulants (DOACs) for the management of SVT; however, this indication remains off-label in many countries due to the scarce evidence.

Aims: The goal of this study is to assess the efficacy and safety of DOACs for the treatment of SVT.

Methods: MEDLINE and Embase were searched for cohort studies and randomized controlled trials that assessed the use of DOACs against vitamin-k antagonists (VKA), low-molecular weight heparins (LMWH), or no anticoagulation for the treatment of SVT. Article screening and data collection was done in duplicate. The primary efficacy outcome was complete recanalization, and the primary safety outcome was major bleeding. Secondary outcomes included recurrent thrombosis, mortality, and partial recanalization. Meta-analysis was done using DerSimonian and Laird random effects model and reported as odds ratios (ORs) with 95% confidence intervals (CI).

Results: A total of nine non-randomized (n=1180 patients) and one randomized study (n=80 patients) were included for analysis (table 1). Meta-analysis of odds ratios is found in table 2. The use of DOACs was associated with an increased rate of complete recanalization in randomized and non-randomized studies when compared to VKAs or no anticoagulation and an increased rate of partial recanalization when compared to VKA, LMWH orVKAs, or no anticoagulation. Both bleeding, death, and recurrent thrombosis appeared to be reduced compared with VKAs in the single randomized study and occurred at a similar rate as the comparator therapy in the non-randomized studies.

Conclusion(s): The use of DOACs for the treatment of SVT appears safe and effective. Ideally this intervention would be tested in a large, randomized study, but the low frequency of SVT makes conducting randomized studies difficult.