Advanced

Improved Prognosis and Low Failure Rate with Anticoagulation as First-Line Therapy in Mesenteric Venous Thrombosis

Salim, S LU ; Zarrouk, M LU ; Elf, J LU ; Gottsäter, A LU ; Ekberg, O LU and Acosta, S LU (2018) In World Journal of Surgery 42(11). p.3803-3811
Abstract

BACKGROUND: Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed.

METHODS: Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015.

RESULTS: The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated... (More)

BACKGROUND: Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed.

METHODS: Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015.

RESULTS: The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000-2007) and 3.2% in the latter (2008-2015) part of the study period (p = 0.006). Age ≥75 years (OR 12.4, 95% CI [2.5-60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3-54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2-51.6]) were independently associated with increased mortality in multivariable analysis.

CONCLUSIONS: Short-term prognosis in patients with MVT has improved. Contemporary data show that monotherapy with anticoagulation is an effective first choice in MVT patients.

(Less)
Abstract (Swedish)
Background Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed.

Methods Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015.

Results The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation
therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were... (More)
Background Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed.

Methods Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015.

Results The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation
therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and
eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000–2007)
and 3.2% in the latter (2008–2015) part of the study period (p = 0.006). Age C75 years (OR 12.4, 95% CI [2.5–60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3–54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2–51.6]) were independently associated with increased mortality
in multivariable analysis.

Conclusions Short-term prognosis in patients with MVT has improved. Contemporary data show that monotherapy
with anticoagulation is an effective first choice in MVT patients. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Mesenteric venous thrombosis, anticoagulation, prognosis, therapy
in
World Journal of Surgery
volume
42
issue
11
pages
3803 - 3811
publisher
Springer
external identifiers
  • scopus:85047129447
  • pmid:29777267
ISSN
1432-2323
DOI
10.1007/s00268-018-4667-x
language
English
LU publication?
yes
id
9befe679-ad92-476e-bcd8-efd8e7c28624
date added to LUP
2018-06-23 11:43:33
date last changed
2019-08-23 02:16:36
@article{9befe679-ad92-476e-bcd8-efd8e7c28624,
  abstract     = {<p>BACKGROUND: Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed.</p><p>METHODS: Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015.</p><p>RESULTS: The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000-2007) and 3.2% in the latter (2008-2015) part of the study period (p = 0.006). Age ≥75 years (OR 12.4, 95% CI [2.5-60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3-54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2-51.6]) were independently associated with increased mortality in multivariable analysis.</p><p>CONCLUSIONS: Short-term prognosis in patients with MVT has improved. Contemporary data show that monotherapy with anticoagulation is an effective first choice in MVT patients.</p>},
  author       = {Salim, S and Zarrouk, M and Elf, J and Gottsäter, A and Ekberg, O and Acosta, S},
  issn         = {1432-2323},
  language     = {eng},
  number       = {11},
  pages        = {3803--3811},
  publisher    = {Springer},
  series       = {World Journal of Surgery},
  title        = {Improved Prognosis and Low Failure Rate with Anticoagulation as First-Line Therapy in Mesenteric Venous Thrombosis},
  url          = {http://dx.doi.org/10.1007/s00268-018-4667-x},
  doi          = {10.1007/s00268-018-4667-x},
  volume       = {42},
  year         = {2018},
}