PB1466 - Safety and efficacy of DOACs in cirrhotic and non-cirrhotic splanchnic vein thrombosis: preliminary results from prospective observational study.

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Rosa Talerico, MD, PhD Student

MD, PhD candidate
Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore
Rome, Lazio, Italy

Co-Author(s)

SB

Silvia Betti

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
FS

Francesco Santopalo

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
FB

Francesca Bartolomei

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
ER

Elena Rossi

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
LG

Lucia Giuli

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
EB

Elena Butera

Dr.
Department of Ageing, Neurosciences, Head-neck and Orthopaedics sciences, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
LD

Luigi Di Martino

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
MP

Maria Pallozzi

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy
AP

Angelo Porfidia

MD
Department of Ageing, Neurosciences, Head-neck and Orthopaedics sciences, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
RP

Roberto Pola

MD
Department of Internal Medicine and Geriatrics, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
VD

Valerio De Stefano

MD
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Lazio, Italy

Background: Splanchnic vein thrombosis (SVT) occur in cirrhotic and non-cirrhotic patients. Anticoagulation with heparins and vitamin K antagonists (VKA) is the mainstay of treatment. Direct oral anticoagulants (DOACs) may offer a viable alternative, but data on their safety and efficacy are still limited.

Aims: The study aim is to prospectively define the incidence of SVT progression/recurrence and major bleeding (MB) events, as defined by ISTH.

Methods: Prospective, single-centre, observational study. Consecutive cirrhotic and non-cirrhotic patients with either recent ( < 6 months) or chronic SVT on DOACs were enrolled between June 2022 and June 2023. Patients were evaluated at 1, 3, and 6 months, and a CT scan was performed at 6 months to assess progression/recurrence of SVT.

Results: 48 were patients enrolled (Table 1). Of 27 patients with chronic SVT, 19 (70%) had a cavernoma. 50% of patients received rivaroxaban, 44% apixaban, 2% dabigatran, and 4% edoxaban. All patients had received previous treatment with heparin or VKA.
Cirrhotic patients more frequently had varices (p=0.002) and previous variceal bleedings (p=0.002). Cirrhotic patients were older (67 vs 55 years, p=0.0003), had lower mean platelets level (87444 vs 285466, p=0.00003) and higher mean bilirubin level (p=0.01). At six-month follow-up, all patients were alive. There were two asymptomatic SVT recurrence/progression episodes (8.4/100 patient-years) and one MB (4.2/100 patient-years). Of two patients with SVT recurrence, one was cirrhotic on apixaban 2.5 mg twice daily (BID), the other non-cirrhotic, with myeloproliferative disease, on rivaroxaban 20 mg once daily; the patient with MB (gastric antral vascular ectasia bleeding) was cirrhotic on dabigatran 110 mg BID. 8 patients had complete recanalization (16.7%), 28 stability (58.3%) and 10 partial regression of SVT (20.8%). Complete recanalization was significantly more frequent in patients with recent SVT (p=0.0009).

Conclusion(s): DOACs appear to be a safe and effective alternative for SVT treatment in cirrhotic and non-cirrhotic patients.