From the Guidelines
The management of Superior Mesenteric Vein (SMV) thrombosis should primarily involve anticoagulation therapy with a continuous infusion of unfractionated heparin. This approach is supported by recent evidence suggesting that anticoagulation is the first-line treatment for mesenteric venous thrombosis 1. The use of anticoagulation therapy has been associated with improved survival and can help prevent further thrombus formation.
Key considerations in the management of SMV thrombosis include:
- Anticoagulation therapy with unfractionated heparin as the initial treatment
- Non-operative management for patients without signs of peritonitis
- Systemic thrombolytic therapy is rarely indicated and should be considered on a case-by-case basis
- Operative intervention is necessary in cases of peritonitis, bowel infarction, or perforation, and should involve resection of only obvious necrotic bowel with liberal use of damage control techniques
It is essential to note that patients with peritonitis require emergency surgery, and intraoperative management should be dictated by surgical findings 1. The aim of resection is to conserve as much bowel as possible, and a second-look laparotomy may be necessary to avoid unnecessary resection of viable bowel. Early use of heparin has been associated with improved survival, highlighting the importance of prompt anticoagulation therapy in the management of SMV thrombosis 1.
From the Research
Management of SMV Thrombosis
The management of Superior Mesenteric Vein (SMV) thrombosis involves several approaches, including:
- Percutaneous pharmaco-mechanical thrombectomy (PPMT) 2
- Transcatheter thrombolysis and aspiration thrombectomy therapy via combined route of superior mesenteric vein and artery (SMV+SMA) 3
- Anticoagulation therapy using heparin and warfarin 4, 5
- Direct oral anticoagulants for eligible patients 5
Treatment Options
Treatment options for SMV thrombosis include:
- PPMT, which has been shown to be safe and effective with an 87.5% long-term survival rate and a 12.5% major complication rate 2
- Transcatheter thrombolysis and aspiration thrombectomy therapy via SMV+SMA, which has been shown to be beneficial in avoiding patient death, resolving thrombus, and improving symptoms 3
- Anticoagulation therapy, which is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism 4, 5
Anticoagulation Therapy
Anticoagulation therapy is an important aspect of SMV thrombosis management, with options including:
- Heparin, which is commonly used for hospitalized patients with atrial fibrillation and atrial flutter 6
- Warfarin, which is recommended for patients with mechanical valves and valvular atrial fibrillation 5
- Direct oral anticoagulants, which are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation 5
Complications and Risks
Complications and risks associated with SMV thrombosis management include: