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

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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 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.

Detaljer

Författare
Enheter & grupper
Externa organisationer
  • Skåne University Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kirurgi

Nyckelord

  • Mesenteric venous thrombosis, anticoagulation, prognosis, therapy
Originalspråkengelska
Sidor (från-till)3803-3811
TidskriftWorld Journal of Surgery
Volym42
Utgivningsnummer11
Tidigt onlinedatum2018 maj 17
StatusPublished - 2018 nov
PublikationskategoriForskning
Peer review utfördJa