Safety and efficacy of direct oral anticoagulants in cirrhotic and non-cirrhotic patients with splanchnic vein thrombosis: preliminary results from sapient study

Introduction Splanchnic vein thrombosis (SVT) is a potentially life-threatening disease that can occur in cirrhotic and non-cirrhotic patients. Anticoagulation with heparins and vitamin K antagonists (VKA) is the mainstay of treatment. Recent studies have suggested that DOACs may offer a viable alternative in these settings, however, data on the safety and efficacy of DOACs are still limited, especially in cirrhotic patients. Aim To prospectively define the incidence of recurrence thrombosis and bleeding events during therapy with DOACs in patients with diagnosed SVT. Materials and Methods Results We conducted a prospective, single-center, observational study. Consecutive cirrhotic and non-cirrhotic patients with either recent (< 6 months) or chronic SVT who started DOACs were enrolled between March to October 2023. At 1 and 3 month patients were evaluated for clinical manifestation of venous thromboembolism and bleeding. At 3 month a CT scan was performed to assess recurrence of SVT. Of the 39 patients enrolled (mean age 58, 53% males, 38% cirrhotic), 17 had a recent SVT (43.5%). Of the 22 patients with chronic SVT, 17 (77%) had a cavernous transformation. Among the 15 cirrhotic patients, 87% were Child A and 13% Child B. 21 patients (54%) started rivaroxaban,16 apixaban (41%) and 2 edoxaban (5%). All patients had a previous treatment with heparins or VKA. Cirrhotic patients had more frequently recent thrombosis (p=0,02), varices (P=0,0003) and previous episodes of variceal bleeding (P=0,002). Cirrhotic patients had lower mean level of platelets (p=0,0002) and higher mean level of bilirubin (P=0,01). No thrombotic or major bleeding events occurred at 3 month follow-up. Concerning recanalization, 22 patients (56,4%) presented stability and 17 regression of SVT. Regression of thrombosis was significantly more frequent in recent SVT (p=0,0009). Conclusions DOACs appears as a potential alternative to standard anticoagulation for the treatment of SVT in cirrhotic and non cirrhotic patients.