PB1471 - A Multidisciplinary Splanchnic Vein Thrombosis Clinic: Experiences from the First Year

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

JB

Jonathan Berry

Instructor in Medicine
Division of Hematology and Hematologic Malignancies, BIDMC
Boston, Massachusetts, United States
CM

Cilomar Martins de Oliveira Filho

PGY-2 Resident
Department of Medicine, Salem Hospital
Salem, Massachusetts, United States
PC

Pavlina Chrysafi

PGY-2 Resident
Department of Medicine, Cambridge Health Alliance
Cambridge, Massachusetts, United States
VR

Vijay Ramalingam

Instructor in Radiology
BIDMC
Boston, Massachusetts, United States
LY

Lauren Yang

Instructor in Medicine
BIDMC
Boston, Massachusetts, United States
MC

Michael Curry

Professor of Medicine
BIDMC
Boston, Massachusetts, United States
MA

Muneeb Ahmed

Professor of Radiology
BIDMC
Boston, Massachusetts, United States
KB

Kenneth Bauer

Professor of Medicine
Division of Hematology and Hematologic Malignancies, BIDMC
Boston, Massachusetts, United States

Presenting Author(s)

Rushad Patell, MBBS

Assistant Professor
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States

Background: Patients with splanchnic venous thrombosis (SpVT) comprise a population with unique and complex care needs, given limited data guiding treatment and the fact that management consistently necessitates consultation and coordination between multiple specialties.

Aims: We present experiences from the first year of a unique multidisciplinary SpVT clinic at our institution.

Methods: We assembled a group of experts across hepatology, interventional radiology, and hematology and began with a weekly multidisciplinary conference to discuss cases of patients with SpVT seen within our divisions. We subsequently launched a weekly, co-located, multidisciplinary clinic immediately following the conference for in-person evaluation of patients (Fig 1).

Results: From launch in September 2022 through July 2023, a total of 111 patients were seen in the clinic. 69 (62.1%) were male, and the median age was 59 (IQR 46.5 - 67.5). 89 (80.1%) patients were seen by a hematologist, 98 (88.2%) by a hepatologist, and 70 (63%) by an interventional radiologist. 53 patients (47.7%) were seen by all three specialties. The most common etiology of SpVT was cirrhosis in 30 patients (27%), followed by idiopathic in 22 patients (19.8%), myeloproliferative neoplasms in 13 patients (11.7%), and post-surgery in 10 patients (9%). Preceding surgeries included gastric sleeve and other abdominal surgeries. Other etiologies included intra-abdominal infection, solid malignancies, inherited thrombotic disorders, pancreatitis, nodular regenerative hyperplasia, post-partum, hormonal therapy and vascular anomalies (Fig 2).

Conclusion(s): We have successfully implemented a multidisciplinary clinic for patients with SpVT, where patients are discussed and seen concurrently by hepatology, hematology, and interventional radiology; the majority of patients see consultants from ≥ 2 specialties. This model is efficient for patients, provides cross-discipline communication, allows for nuanced decision-making, and facilitates clinical research for these complex patients. A multidisciplinary SpVT clinic model could be replicated by other centers.