What is the treatment for splenic vein thrombosis?

From the Guidelines

Treatment of Splenic Vein Thrombosis Treatment of splenic vein thrombosis typically involves anticoagulation therapy with low molecular weight heparin (LMWH), such as enoxaparin, at a dose of 1mg/kg twice daily, or unfractionated heparin, at a dose of 80-100 units/kg bolus followed by 18 units/kg/hour infusion, for a minimum of 3-6 months 1.

Anticoagulation Options

• LMWH: enoxaparin, at a dose of 1mg/kg twice daily
• Unfractionated heparin: at a dose of 80-100 units/kg bolus followed by 18 units/kg/hour infusion
• Oral anticoagulants: such as warfarin, with a target international normalized ratio (INR) of 2.0-3.0, may be used for long-term anticoagulation 1

Key Considerations

• Duration of anticoagulation: should be at least 3 months or as long as active cancer or cancer therapy 1
• Supportive care: including pain management with acetaminophen or opioids, and treatment of underlying conditions, such as pancreatitis or splenomegaly, may be necessary
• Monitoring: regular monitoring of laboratory tests, such as complete blood count, renal and hepatic function panel, and INR, is crucial to adjust anticoagulation therapy as needed 1

Special Considerations

• Cancer patients: anticoagulation therapy should be individualized based on the patient's risk factors, such as renal impairment, hepatic disease, and bleeding risk 1
• Incidental splenic vein thrombosis: anticoagulation therapy may not be necessary for asymptomatic patients, but should be considered for symptomatic patients or those with extensive thrombosis 1

From the Research

Treatment Options for Splenic Vein Thrombosis

• The treatment for splenic vein thrombosis may involve anticoagulation therapy, with the goal of preventing the extension, embolization, and recurrence of thrombosis 2.
• Low-molecular-weight heparins (LMWHs) have been shown to be effective and safe in the treatment of deep vein thrombosis, and may be used as an alternative to unfractionated heparin (UFH) 3, 4, 5.
• Direct oral anticoagulants (DOACs) may also be used in the treatment of splanchnic vein thrombosis, including splenic vein thrombosis, and have been shown to be effective and safe in non-cirrhotic patients 6.
• The choice of anticoagulant and duration of treatment will depend on the individual patient's risk factors and clinical characteristics, and may involve a combination of LMWHs, DOACs, and/or vitamin K antagonists (VKAs) 2, 6.

Anticoagulation Therapy

• LMWHs, such as enoxaparin and dalteparin, may be given subcutaneously once or twice daily, and have been shown to be effective and safe in the treatment of deep vein thrombosis 3, 5.
• DOACs, such as rivaroxaban and apixaban, may be given orally once or twice daily, and have been shown to be effective and safe in the treatment of splanchnic vein thrombosis, including splenic vein thrombosis 6.
• VKAs, such as warfarin, may be given orally once daily, and have been shown to be effective in the treatment of deep vein thrombosis, but may require more frequent monitoring and dose adjustments 4, 2.

Duration of Treatment

• The duration of anticoagulation therapy will depend on the individual patient's risk factors and clinical characteristics, and may range from several months to several years 2, 6.
• Patients with a high risk of recurrence, such as those with cancer or antiphospholipid syndrome, may require extended anticoagulation therapy 2.
• Patients with a low risk of recurrence, such as those with a transient risk factor, may require shorter anticoagulation therapy 2.