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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2023; 29(33): 4962-4974
Published online Sep 7, 2023. doi: 10.3748/wjg.v29.i33.4962
Direct oral anticoagulants for the treatment of splanchnic vein thrombosis: A state of art
Giovanni Monaco, Luca Bucherini, Bernardo Stefanini, Fabio Piscaglia, Francesco Giuseppe Foschi, Luca Ielasi
Giovanni Monaco, Bernardo Stefanini, Fabio Piscaglia, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
Giovanni Monaco, Bernardo Stefanini, Fabio Piscaglia, Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
Luca Bucherini, Francesco Giuseppe Foschi, Luca Ielasi, Department of Internal Medicine, Ospedale degli Infermi di Faenza, Faenza 48018, Italy
Author contributions: Monaco G, Bucherini L, Stefanini B and Ielasi L conceived the manuscript, reviewed the literature and wrote the original draft; Monaco G and Ielasi L reviewed and edited the manuscript; Piscaglia F and Foschi FG supervised; All authors read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Ielasi, MD, Doctor, Department of Internal Medicine, Ospedale degli Infermi di Faenza, Viale Stradone, 9, Faenza 48018, Italy. luca.ielasi.kr@gmail.com
Received: June 27, 2023
Peer-review started: June 27, 2023
First decision: July 25, 2023
Revised: August 7, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: September 7, 2023
Processing time: 65 Days and 17 Hours
Abstract

Splanchnic vein thrombosis (SVT) is a manifestation of venous thromboembolism in an unusual site. Portal, mesenteric, and splenic veins are the most common vessels involved in SVT which occurs mainly in patients with liver cirrhosis, although non-cirrhotic patients could be affected as well. Thrombosis of hepatic veins, also known as Budd-Chiari syndrome, is another manifestation of SVT. Prompt diagnosis and intervention are mandatory in order to increase the recalization rate and reduce the risk of thrombus progression and hypertensive complications. Traditional anticoagulation with heparin and vitamin-K antagonists is the treatment of choice in these cases. However, recent studies have shown promising results on the efficacy and safety of direct oral anticoagulants (DOACs) in this setting. Available results are mainly based on retrospective studies with small sample size, but first clinical trials have been published in the last years. This manuscript aims to provide an updated overview of the current evidence regarding the role of DOACs for SVT in both cirrhotic and non-cirrhotic patients.

Keywords: Splanchnic vein thrombosis; Portal vein thrombosis; Budd-Chiari syndrome; Direct oral anticoagulants

Core Tip: The term splanchnic vein thrombosis (SVT) includes portal vein thrombosis and Budd-Chiari syndrome. Both conditions could occur in patients with and without an underlying liver disease. The cornerstone of treatment is anticoagulation. Direct oral anticoagulants (DOACs) are a novel class of drugs that have strongly affirmed their role in the management of patients with atrial fibrillation and venous thromboembolism. In the last few years, several studies have been published showing promising results in efficacy and safety of DOACs in patients with SVT.