Open AccessImproved Prognosis and Low Failure Rate with Anticoagulation as First‐Line Therapy in Mesenteric Venous Thrombosis
Author(s) -
Salim S.,
Zarrouk M.,
Elf J.,
Gottsäter A.,
Ekberg O.,
Acosta S.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4667-x
Subject(s) - medicine , bowel resection , surgery , thrombosis , abdominal surgery , vascular surgery , mortality rate , incidence (geometry) , short bowel syndrome , retrospective cohort study , venous thrombosis , cardiac surgery , parenteral nutrition , physics , optics
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 ≥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.