Liver and Bile
J Hepatol. 2023;78(1):114–22
Incidence and factors predictive of recurrent thrombosis in people with non-cirrhotic portal vein thrombosis
Background and aims: Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that there is a very low risk of recurrent thrombosis (RT). The authors’ first aim was to describe the incidence of RT in people with NC-SVT without an indication for long-term anticoagulation. Their second aim was to identify RT risk factors and afterwards verify them in a validation cohort.
Methods: This is a multicenter, retrospective observational study evaluating risk factors for RT in 64 people with NC-SVT of idiopathic/local factor etiology. In a subgroup of 48 individuals, the potential value of additional thrombophilic parameters to predict RT was analyzed. Findings were validated in 70 individuals with idiopathic/local factor NC-SVT.
Results: Of the 64 participants in the training cohort, 17 (26%) presented splanchnic and/or extrasplanchnic RT (overall-RT) during follow-up (cumulative incidence: 2%, 10%, 19%, and 34% at 1, 2, 5, and 10 years, respectively). In addition, 53% of people with splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 people with an additional comprehensive thrombophilic study, factor VIII ≥ 150% was the only independent factor predicting overall-RT (hazard ratio [HR] = 7.10, 95% confidence interval [CI]: 2.17–23.17, p < 0.01). In the validation cohort, 19 individuals (27%) presented overall-RT, and it was also independently predicted by factor VIII > 150% (HR = 3.71, 95% CI: 1.31–10.5, p < 0.01). The predictive value of factor VIII was confirmed in both people with idiopathic/local factor etiology-associated NC-SVT.
Conclusions: People with idiopathic/local factor non-cirrhotic splanchnic vein thrombosis (NC-SVT) are at risk of overall-recurrent thrombosis (RT). Splanchnic RT can be asymptomatic and requires screening for its detection. Values of factor VIII ≥ 150% may help identify individuals at high risk of overall-RT who could benefit from long-term anticoagulation.