Splanchnic Vein Thrombosis: Risk Factors, Clinical Presentation, Diagnosis, Treatment

Splanchnic vein thrombosis is an uncommon manifestation of venous thromboembolism which encompasses one or more abdominal veins (portal, splenic, mesenteric and supra-hepatic veins). Splanchnic vein thrombosis may be related to variable underlying disorders, either local (abdominal cancer, liver cirrhosis, intra-abdominal inflammation or surgery) or systemic (hormonal treatment, thrombophilia conditions, myeloproliferative neoplasms, paroxysmal nocturnal haemoglobinuria or autoimmune diseases). Splanchnic vein thrombosis occurs with heterogeneous clinical presentations, extending from incidental finding to symptomatic thrombosis associated with gastrointestinal bleeding. Due to diagnostic and clinical complexity there is a clinical challenge for treatment decisions. In the absence of major contraindications, anticoagulant therapy is usually suggested for all patients presenting with acute symptomatic splanchnic vein thrombosis, but there is no recommendation about the use of anticoagulant drugs in chronic or incidentally detected episodes. There is no clear evidence on the acute and long-term management and the ratio between the risk and the benefit of using anticoagulant therapy in splanchnic vein thrombosis still needs to be well evaluated.