Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)

Research Article Volume 3 Issue 6

Clinical and Etiological Profile of Patients with Splanchnic Venous Thrombosis in a Tertiary Care Centre from Southern India

Ravindra L Gaadhe, Pawar Abhimanrao Manikrao*, K R Palaniswamy and Piramanayagam P

Department of Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India.

*Corresponding Author: Pawar Abhimanrao Manikrao, Department of Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India.

Received: April 16, 2020; Published: May 27, 2020

×

Abstract

Background: Splanchnic vein thrombosis (SVT) is an uncommon, but potentially life-threatening disease. An etiologic factor can be identified in about 25 - 75% of patients as reported in western literature. This study was done to evaluate thrombotic factors including JAK2V617F mutation in patients with SVT.

Aim: To evaluate clinical and etiological profile of patients with splanchnic venous thrombosis.

Methods: All patients with SVT diagnosed with CECT abdomen attending our institute from April 2011 to May 2013 were screened. Patients with malignancy, intra-abdominal inflammatory conditions or surgery in the preceding three months were excluded. A thrombophilia work-up (protein C, S and AT-III deficiency, APCR, ACLA and LA, homocysteine level and JAK2V617F mutation) was done.

Results: Total 39 patients were included (mean age: 45.9 ± 15.2 years; M:F  1.6:1). 29 patients (74.3%) had portal vein thrombosis (PVT), 6 (15.4%) had BCS and 4 (7.6%) had isolated mesenteric vein thrombosis. Isolated PVT was found in 8/29 (27.5%). 21/29 (72.5%) had additional one or more accessory vein involved. Site of thrombosis in BCS patients was in HV (50%), HV and IVC (33.3%) and HV and PV (16.7%). The common symptoms were abdominal pain (48%), ascites (38.5%), pedal edema (30%), splenomegaly (25.6%) and gastrointestinal bleeding (15%). 23% (9/39) patients were asymptomatic. Cirrhosis was found in 10/29 (34.4%) patients in PVT group. 50% patients had one thrombotic factor, 30% had two or more factors and 20% had none. JAK2V617F mutation was found in 5/39 (12.8%) patients. None of the cirrhotic patients had JAK2V617F mutation.

Conclusion: Splanchnic vein thrombosis usually presents as a chronic disease. A prothrombotic state was detected in 80% of patients. JAK2V617F mutation was detected in 12.8% patients.

Keywords: Splanchnic Venous Thrombosis (SVT); Tertiary Care Centre; Thrombophilia

×

References

  1. Amitrano L., et al. “Prognostic factors in noncirrhotic patients with splanchnic vein thromboses”. The American Journal of Gastroenterology 11 (2007): 2464-2470.
  2. Gertsch P., et al. “Acute thrombosis of the splanchnic veins”. Archives of Surgery 3 (1993): 341-345.
  3. Kumar S., et al. “Mesenteric venous thrombosis”. The New England Journal of Medicine 23 (2001): 1683-1688.
  4. Sobhonslidsuk A and Reddy KR. “Portal vein thrombosis: a concise review”. The American Journal of Gastroenterology 3 (2002): 535-541.
  5. Janssen HL., et al. “Budd-Chiari syndrome: a review by an expert panel”. Journal of Hepatology 3 (2003): 364-371.
  6. Lee HK., et al. “Portal vein thrombosis: CT features”. Abdom Imaging1 (2008): 72-79.
  7. Brancatelli G., et al. “Budd-Chiari syndrome: spectrum of imaging findings”. The American Journal of Roentgenology 2 (2007): W168-W176.
  8. Brown KM., et al. “Extrahepatic portal venous thrombosis: frequent recognition of associated diseases”. Journal of Clinical Gastroenterology 7 (1985): 153-159.
  9. Denninger MH., et al. “Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors”. Hepatology 31 (2000): 587-591.
  10. Klein AS. “Management of Budd-Chiari syndrome”. Liver Transplantation 12 (2006): S23-S28.
  11. De Stefano V., et al. “Spontaneous erythroid colony formation as the clue to an underlying myeloproliferative disorder in patients with Budd-Chiari syndrome or portal vein thrombosis”. Seminars in Thrombosis and Hemostasis 23 (1997): 411-418.
  12. Valla D., et al. “Primary myeloproliferative disorder and hepatic vein thrombosis. A prospective study of erythroid colony formation in vitro in 20 patients with Budd-Chiari syndrome”. Annals of Internal Medicine 103 (1985): 329-334.
  13. Pardanani A., et al. “JAK2V617F mutation screening as part of the hypercoagulable work-up in the absence of splanchnic venous thrombosis or overt myeloproliferative neoplasm: assessment of value in a series of 664 consecutive patients”. Mayo Clinic Proceedings 4 (2008): 457-459.
  14. Abdu RA., et al. “Mesenteric venous thrombosis--1911 to 1984”. Surgery 101 (1987): 383-388.
  15. Zeitoun G., et al. “Outcome of Budd-Chiari syndrome: a multivariate analysis of factors related to survival including surgical portosystemic shunting”. Hepatology 30 (1999): 84-89.
  16. Slakey DP., et al. “Budd-Chiari syndrome: current management options”. Annals of Surgery 233 (2001): 522-527.
  17. Condat B., et al. “Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy”. Gastroenterology 120 (2001): 490.
  18. DeLeve LD., et al. “Vascular disorders of the liver”. Hepatology 49 (2009): 1729-1764.
  19. De Franchis R. “Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension”. Journal of Hepatology 53 (2010): 762-768.
  20. Tang T., et al. “The prognostic value of histology in the assessment of patients with Budd-Chiari syndrome”. Journal of Hepatology 35 (2001): 338-343.
  21. Darwish Murad S., et al. “Etiology, management, and outcome of the Budd-Chiari syndrome”. Annals of Internal Medicine 151 (2009): 167-175.
  22. Rajani R., et al. “Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival - an 18-year experience”. Liver International 29 (2009): 253-259.
  23. Mohanty D., et al. “Hereditary thrombophilia as a cause of Budd-Chiari syndrome: a study from Western India”. Hepatology 34 (2001): 666-670.
  24. Bhattacharyya M., et al. “Inherited prothrombotic defects in Budd-Chiari syndrome and portal vein thrombosis: a study from North India”. American Journal of Clinical Pathology 121 (2004): 844-847.
  25. Amarapurkar DN., et al. “Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment”. World Journal of Gastroenterology 2 (2008): 278-285.
  26. Shetty S., et al. “JAK2 Mutations Across a Spectrum of Venous Thrombosis Cases”. American Journal of Clinical Pathology 134 (2010): 82-85.
  27. Madanagopalan N., et al. “Clinical spectrum and surgical relief of chronic obstruction of hepatic and suprahepatic segment of inferior vena cava of chronic Budd Chiari syndrome”. Journal of Gastroenterology and Hepatology 1 (1986): 359-369.
  28. Dilawari JB., et al. “Hepatic outflow obstruction (Budd-Chiari syndrome). Experience with 177 patients and a review of the literature”. Medicine (Baltimore) 73 (1994): 21-36.
  29. Thatipelli MR., et al. “Survival and recurrence in patients with splanchnic vein thromboses”. Clinical Gastroenterology and Hepatology 8 (2010): 200-205.
  30. Sutkowska E., et al. “Thrombophilia differences in splanchnic vein thrombosis and lower extremity deep venous thrombosis in North America”. World Journal of Gastroenterology 10 (2012): 1111-1118.
  31. Deepak A., et al. “Prevalence of JAK2V617F mutation in intra-abdominal venous thrombosis”. Tropical Gastroenterology4 (2011): 279-284.
  32. Dutta AK., et al. “Risk factors of thrombosis in abdominal veins”. World Journal of Gastroenterology 28 (2008): 4518-4522.
  33. Smalberg JH., et al. “Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis”. Blood25 (2012): 4921-4928.
  34. Eapen CE., et al. “Changing profile of Budd Chiari syndrome in India”. Indian Journal of Gastroenterology 2 (2007): 77-81.
×

Citation

Citation: Pawar Abhimanrao Manikrao., et al. “Clinical and Etiological Profile of Patients with Splanchnic Venous Thrombosis in a Tertiary Care Centre from Southern India”. Acta Scientific Gastrointestinal Disorders 3.6 (2020): 17-23.



Member In





News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 15, 2020.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US