Abdominal thromboses of splanchnic, renal and ovarian veins

• Published in: Best practice & research. Clinical haematology 2012-09, Vol.25 (3), p.253-264
• Main Authors: De Stefano, Valerio, MD, Martinelli, Ida, MD, PhD
• Format: Article
• Language: English
• Subjects: Anticoagulants - pharmacology; Anticoagulants - therapeutic use; Biomarkers, Tumor - metabolism; Budd-Chiari Syndrome - complications; Budd-Chiari Syndrome - diagnosis; Budd-Chiari Syndrome - drug therapy; Budd-Chiari Syndrome - pathology; Budd–Chiari syndrome; extrahepatic portal vein thrombosis; Female; Hematology, Oncology and Palliative Medicine; Heparin - pharmacology; Heparin - therapeutic use; Humans; Janus Kinase 2 - metabolism; Leukemia - complications; Leukemia - diagnosis; Leukemia - drug therapy; Leukemia - pathology; mesenteric vein thrombosis; Nephrotic Syndrome - complications; Nephrotic Syndrome - diagnosis; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - pathology; ovarian vein thrombosis; Ovary - pathology; Portal Vein - pathology; renal vein thrombosis; Splanchnic Circulation; Vena Cava, Inferior - pathology; Venous Thrombosis - complications; Venous Thrombosis - diagnosis; Venous Thrombosis - drug therapy; Venous Thrombosis - pathology; Vitamin K - antagonists & inhibitors
• ISSN: 1521-6926; 1532-1924
• DOI: 10.1016/j.beha.2012.07.002

Thromboses of abdominal veins outside the iliac–caval axis are rare but clinically relevant. Early deaths after splanchnic vein thrombosis occur in 5–30% of cases. Sequelae can be liver failure or bowel infarction after splanchnic vein thrombosis, renal insufficiency after renal vein thrombosis, ovarian infarction after ovarian vein thrombosis. Local cancer or infections are rare in Budd–Chiari syndrome, and common for other sites. Inherited thrombophilia is detected in 30–50% of patients. Myeloproliferative neoplasms are the main cause of splanchnic vein thrombosis: 20–50% of patients have an overt myeloproliferative neoplasm and/or carry the molecular marker JAK2 V617F. Renal vein thrombosis is closely related to nephrotic syndrome; finally, ovarian vein thrombosis can complicate puerperium. Heparin is used for acute treatment, sometimes in conjunction with systemic or local thrombolysis. Vitamin K-antagonists are recommended for 3–6 months, and long-term in patients with Budd-Chiari syndrome, unprovoked splanchnic vein thrombosis, or renal vein thrombosis with a permanent prothrombotic state such as nephrotic syndrome.