Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

Overview

Journal Gastrointest Tumors

Date 2021 May 13

PMID 33981685

Citations 3

Authors

Shivani Handa

Kamesh Gupta

Michelle Sterpi

Ahmad Khan

Abhinav Hoskote

Anup Kasi

Affiliations

Soon will be listed here.

Abstract

Introduction: Gastrointestinal cancers have a strong association with splanchnic vein thrombosis (SVT), yet the hospitalization data is unknown.

Objective And Methods: We analyzed around 78 million discharges from the 2007-2017 Nationwide Inpatient Sample with an inclusion criterion of adult patients admitted for portal or hepatic vein thrombosis as a primary diagnosis with a gastrointestinal or hepatobiliary malignancy as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models.

Results: Out of the total 32,324 hospitalizations for SVT, 3,220 (10%) were associated with a GI malignancy, of which hepatocellular carcinoma (HCC) and pancreatic cancer were the most common. Portal vein thrombosis accounted for 95% of these hospitalizations. Admissions for pancreatic cancer-associated SVT have increased by 7.2 times from 2007 to 2017. Patients with SVT and concomitant GI malignancies were significantly older and had a higher comorbidity score than those with SVT without GI malignancy. Risk of inpatient mortality for SVT patients were significantly higher for patients with gastric cancer (rate: 12.1%, OR 8.6, 95% CI: 1.8-39.7) and HCC (rate: 7.6%, OR 2.77, 95% CI 1.5-4.8) as compared to non-GI malignancy-related SVT. Odds of variceal bleeding were significantly higher for patients with HCC (OR 1.67, 95% CI: 1.2-2.34) than patients without GI malignancy.

Conclusions: Digestive cancer-associated SVTs constitute 10% of all SVT related hospitalizations and are significantly increasing in the past decade. We report the baseline characteristics and predictors of inpatient mortality in this study.

Citing Articles

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Borbely R, Teutsch B, Hegyi P United European Gastroenterol J. 2025; 13(1):86-96.

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Shang H, Jiang J, Guffey D, Novoa F, Bandyo R, Ma S J Thromb Haemost. 2024; 22(5):1421-1432.

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Cancer-Associated Abdominal Vein Thrombosis.

Muscat-Baron L, Borg A, Attard L, Gatt A, Riva N Cancers (Basel). 2023; 15(21).

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References

Kearon C, Akl E, Ornelas J, Blaivas A, Jimenez D, Bounameaux H . Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2):315-352. DOI: 10.1016/j.chest.2015.11.026. View

Quirk M, Kim Y, Saab S, Lee E . Management of hepatocellular carcinoma with portal vein thrombosis. World J Gastroenterol. 2015; 21(12):3462-71. PMC: 4375567. DOI: 10.3748/wjg.v21.i12.3462. View

Serrano P, Parpia S, Linkins L, Elit L, Simunovic M, Ruo L . Venous Thromboembolic Events Following Major Pelvic and Abdominal Surgeries for Cancer: A Prospective Cohort Study. Ann Surg Oncol. 2018; 25(11):3214-3221. DOI: 10.1245/s10434-018-6671-7. View

Smalberg J, Kruip M, Janssen H, Rijken D, Leebeek F, de Maat M . Hypercoagulability and hypofibrinolysis and risk of deep vein thrombosis and splanchnic vein thrombosis: similarities and differences. Arterioscler Thromb Vasc Biol. 2011; 31(3):485-93. DOI: 10.1161/ATVBAHA.110.213371. View

Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby N . Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006; 12(13):2115-9. PMC: 4087695. DOI: 10.3748/wjg.v12.i13.2115. View

Chew H, Wun T, Harvey D, Zhou H, White R . Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006; 166(4):458-64. DOI: 10.1001/archinte.166.4.458. View

Khorana A, Fine R . Pancreatic cancer and thromboembolic disease. Lancet Oncol. 2004; 5(11):655-63. DOI: 10.1016/S1470-2045(04)01606-7. View

Thodiyil P, Kakkar A . Variation in relative risk of venous thromboembolism in different cancers. Thromb Haemost. 2002; 87(6):1076-7. View

Tufano A, Ageno W, Di Micco P, Niglio A, Rosa V, Ballaz A . Outcomes during anticoagulation in patients with symptomatic vs. incidental splanchnic vein thrombosis. Thromb Res. 2018; 164:69-74. DOI: 10.1016/j.thromres.2018.02.143. View

10.

Cerrito L, Annicchiarico B, Iezzi R, Gasbarrini A, Pompili M, Ponziani F . Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers. World J Gastroenterol. 2019; 25(31):4360-4382. PMC: 6710186. DOI: 10.3748/wjg.v25.i31.4360. View

11.

Afzal A, Suhong L, Gage B, Schoen M, Carson K, Thomas T . Splanchnic vein thrombosis predicts worse survival in patients with advanced pancreatic cancer. Thromb Res. 2019; 185:125-131. DOI: 10.1016/j.thromres.2019.11.023. View

12.

Rajani R, Melin T, Bjornsson E, Broome U, Sangfelt P, Danielsson A . Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival - an 18-year experience. Liver Int. 2008; 29(2):253-9. DOI: 10.1111/j.1478-3231.2008.01838.x. View

13.

Liu P, Huo T, Miksad R . Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best Management Strategies. Semin Liver Dis. 2018; 38(3):242-251. DOI: 10.1055/s-0038-1666805. View

14.

Mier Hicks A, DeRosa A, Raj M, Do R, Yu K, Lowery M . Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review. Clin Colorectal Cancer. 2018; 17(2):e207-e216. PMC: 6752720. DOI: 10.1016/j.clcc.2017.12.001. View

15.

Regnault H, Emambux S, Lecomte T, Doat S, Dhooge M, Besson M . Clinical outcome of portal vein thrombosis in patients with digestive cancers: A large AGEO multicenter study. Dig Liver Dis. 2017; 50(3):285-290. DOI: 10.1016/j.dld.2017.11.001. View

16.

Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A . Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. 2018; 380(8):711-719. DOI: 10.1056/NEJMoa1814468. View

17.

Khorana A, Soff G, Kakkar A, Vadhan-Raj S, Riess H, Wun T . Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer. N Engl J Med. 2019; 380(8):720-728. DOI: 10.1056/NEJMoa1814630. View

18.

Manzano-Robleda M, Barranco-Fragoso B, Uribe M, Mendez-Sanchez N . Portal vein thrombosis: what is new?. Ann Hepatol. 2014; 14(1):20-7. View

19.

Jiang J, Lao Y, Yuan B, Yin J, Liu X, Chen L . Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges. Oncotarget. 2017; 8(20):33911-33921. PMC: 5464922. DOI: 10.18632/oncotarget.15411. View

20.

Gupta K, Khan A, Goyal H, Cal N, Hans B, Martins T . Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the 'weekend effect'. Ann Hepatol. 2020; 19(5):523-529. DOI: 10.1016/j.aohep.2020.05.005. View