American Journal of Gastroenterology ISSN 0002-9270 C  2007 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2007.01477.x Published by Blackwell Publishing Prognostic Factors in Noncirrhotic Patients With Splanchnic Vein Thromboses Lucio Amitrano, M.D., 1 Maria Anna Guardascione, M.D., 1 Mariano Scaglione, M.D., 2 Luca Pezzullo, M.D., 3 Nicola Sangiuliano, M.D., 4 Mariano F. Armellino, M.D., 4 Francesco Manguso, M.D., 1 Maurizio Margaglione, M.D., 6,8 Paul R. J. Ames, M.D., 7 Luigi Iannaccone, B.Sc., 5 Elvira Grandone, M.D., 8 Luigia Romano, M.D., 2 and Antonio Balzano, M.D. 1 1 Gastroenterologia, 2 Dipartimento di Radiologia, 3 Ematologia, 4 Osservazione Chirurgica, 5 Unita’ di Emostasi e Trombosi, A. Cardarelli Hospital, Naples, Italy; 6 Genetica Medica, Universit` a di Foggia, Foggia, Italy; 7 Department of Haematology, Inverclyde Royal Hospital, Greenock, Scotland; 8 Unit` a di Emostasi e Trombosi, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italia OBJECTIVES Splanchnic vein thrombosis (SVT), not associated with cancer or liver cirrhosis, is a rare event and AND METHODS: scanty data are available on its natural history, long-term prognosis, and treatment. In this study 121 SVT patients consecutively seen from January 1998 to December 2005 were included and 95 of them were followed up for a median time of 41 months. Screening for thrombophilic factors was performed in 104 patients. New thrombotic or bleeding episodes were registered and anticoagulant therapy was performed according to preestablished criteria. RESULTS: SVT was an incidental finding in 34 (28.1%) patients; 34 (28.1%) presented with abdominal infarction; 39 (32.2%) had bowel ischemia or acute portal vein thrombosis; 14 (11.6%) had bleeding from portal hypertensive sources. Survival rates at 1, 3, and 7 yr were 95%, 93.3%, and 89.6%, respectively; 87.5% of deaths occurred at onset of SVT as complications of intestinal infarction. Patients with isolated portal vein thromboses had symptoms and intestinal infarction in 16/41 (39%) and 0/41 (0%) of the cases, respectively, whereas superior mesenteric vein thromboses, isolated or not, were associated with symptoms and intestinal infarction in 69/75 (92%) and 34/75 (45%), respectively. During the follow-up 14 (14.7%) suffered from 39 episodes of gastrointestinal bleeding with no deaths. A previous gastrointestinal bleed was associated with new hemorrhagic events during follow-up. New venous thrombotic episodes occurred in 10 of 95 patients (10.5%), of which 73% were in the splanchnic area. Seven out of these 10 patients had a chronic myeloproliferative disease (MPD) and none was on anticoagulation. CONCLUSIONS: Anticoagulant therapy was effective to obtain recanalization of acute SVT in 45.4% of patients and preserved patients from recurrent thrombosis when given lifelong. (Am J Gastroenterol 2007;102:2464–2470) INTRODUCTION Thromboses of the portal, splenic, and mesenteric veins or splanchnic vein thromboses (SVT) are rare disorders in the absence of abdominal cancer or liver cirrhosis. In the past, SVT were suspected mostly in patients presenting with re- current bleeding from esophageal varices without overt liver disease (1). In the last decade the availability of advanced imaging procedures such as Doppler ultrasound, computer tomography (CT), and magnetic resonance imaging (MRI) allowed a better diagnosis of SVT in a large number of clin- ical settings ranging from fortuitous asymptomatic occlu- sions to acute abdomen. Moreover, the possibility of diag- nosing SVT earlier results in a more prompt and effective therapy that translates in decreased morbidity and mortality (2, 3). In similarity with thrombosis in other venous districts, SVT may develop according to a complex interplay of local or systemic factors including inherited or acquired throm- bophilia (4–7). Given the rarity of SVT, studies comparing the different therapeutic options (thrombolysis, anticoagula- tion, thrombectomy) are not available, but anticoagulation is widely accepted as first choice therapy with strong clinical evidence to support its use in acute presentations. On the other hand, long-term prognosis, morbidity, and mortality of SVT are largely unknown and no data are available to identify those patients in which lifelong anticoagulation is necessary to prevent recurrent thrombosis. We describe our experience 2464