Splenic vein thrombosis medical therapy

Medical therapy for splenic vein thrombosis include anticoagulation to maintain INR between 2 to 3. The goal of anticoagulation is to prevent extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop. The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding.

Medical therapy for splenic vein thrombosis include anticoagulation to maintain INR between 2 to 3. The goal of anticoagulation is to prevent extension of the clot and to allow for recanalization so that intestinal infarction and portal hypertension do not develop. The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding.^{[1][2][3][4][5]}

• Correction of the causal factors
  • Prevention of thrombosis extension
  • Achievement of splenic vein patency
  • Management of complications related to pancreatitis
  • NOTE (1):Initiate anticoagulation with heparin for 3-4 weeks then start oral vitamin K antagonist(e.g. warfarin) to maintain INR between 2 to 3
  • Improves recanalization rates
  • Decrease development of gastric varices and complications associated with varices

• 2.1 Chronic splenic vein thrombosis
  • 2.1.1 Chronic splenic vein thrombosis with hypercoagulable state or previous history of vascular disease
  • 2.1.1.1 Long term anticoagulation
  • Preferred regimen: Warfarin 2-5 mg PO q24h
  • 2.1.1.2 Treatment ofGastric varices
  • 2.1.2. Chronic splenic vein thrombosis without hypercoagulable state or previous history of vascular disease
  • NOTE: Chronic anticoagulation is generally not recommended
  • 2.1.2.1 Treatment of gastric varices
• 2.2 Acute splenic vein thrombosis
  • 2.1 Anticoagulant therapy
    • 2.1.1 Acute splenic vein thrombosis with hypercoagulable state
    • Preferred regimen: Warfarin 2-5 mg PO q24h for long term
    • 2.2.2 Acute splenic vein thrombosis without hypercoagulable state
    • Preferred regimen: Warfarin 2-5 mg PO q24h for 3-6 months
  • 2.2 Thrombolytic therapy
    • Preferred regimen: Recombinant tissue plasminogen activator (RTPA)^[6]
    • Alternate regimen(1): Urokinase^[7]
    • Alternate regimen(2): Streptokinase^[7] The mainstay of therapy in splenic vein thrombosis with gastric varices is sclerotherapy and gastric banding