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. 2018 Jun;17(2):121-128.
doi: 10.1016/j.clcc.2018.01.008. Epub 2018 Jan 31.

Incidence, Management, and Implications of Visceral Thrombosis in Pancreatic Ductal Adenocarcinoma

Angel Mier-Hicks  1 , Michael Raj  2 , Richard Kinh Do  2 , Kenneth H Yu  3 , Maeve A Lowery  4 , Anna Varghese  4 , Eileen M O'Reilly  5
Affiliations

Incidence, Management, and Implications of Visceral Thrombosis in Pancreatic Ductal Adenocarcinoma

Angel Mier-Hicks et al. Clin Colorectal Cancer. 2018 Jun.

Abstract

Background: Visceral or splanchnic thrombosis is defined as thrombi within the hepatoportal venous system, including portal (PV), mesenteric (MV), and splenic vein (SV), as well as thrombi in renal or gonadal veins. There are limited data to evaluate the prognostic significance, incidence, and clinical management of visceral thromboses in patients with pancreatic ductal adenocarcinoma (PDAC).

Patients and methods: We conducted an analysis of 95 patients treated at Memorial Sloan Kettering Cancer Center with PDAC who had a visceral thrombosis.

Results: A total of 153 visceral thromboses (VsT) were identified in 95 patients (n = 51, 54% woman). A total of 36 patients (37%) had locally advanced disease, and n = 59 (62%) had metastatic disease. Systemic therapies received included FOLFIRINOX (n = 57, 60%) and GC/PTX (n = 27, 28%). All VsT events were incidentally detected. Overall survival of cohort was 12.3 months (range, 10.2-14.4 months). Visceral thrombosis incidence in the cohort was as follows: portal vein (PV) (45%), MV (26%), SV (17%), and gonadal veins (8%). Time to develop first VsT was 4.3 months (range, 3-5.6 months), and time to death from VsT development was 1.87 months (range, 0.8-2.8 months). Forty-five patients (47%) developed a second VsT. Sixty percent had a Khorana risk score of > 3. Thirty-nine patients (41%) were treated with short-term anticoagulation (AC) (< 1 month) (low-molecular-weight heparin, n = 34). Forty-five patients (47%) were treated with long-term AC (> 1 month) (low-molecular-weight heparin, n = 32; 23 were transitioned to an oral anticoagulant). Twenty-two patients (23%) were not treated with AC. Eight patients (8%) had a bleeding complication from AC. Portal vein thrombosis had the shortest overall survival at 3.6 months (range, 2.3-4.8 months).

Conclusion: In PDAC, VsT can frequently present as an incidental finding on routine abdominal imaging. The most common location is PV, followed by MV and SV. We observed that AC is underutilized in this setting despite a low bleeding complication rate. PV was associated with the least overall survival of the VsT. Future large prospective studies should explore the role of AC and value in this setting.

Keywords: Antithrombotic treatment; Mesenteric vein thrombosis; Portal vein thrombosis; Splanchnic vein thrombosis; Splenic vein thrombosis.

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Conflict of interest statement

Conflict(s) of Interest/Disclosures (s):None of the authors have any financial or other relations that could lead to a conflict of interest.

Figures

Figure 1.
Figure 1.
Study Design. N= number of patients, PVT= Portal vein thrombosis, MVT= Mesenteric Vein thrombosis, SVT= Splenic Vein Thrombosis, RVT=Renal Vein Thrombosis, GVT=Gonadal Vein Thrombosis
Figure 2.
Figure 2.
Survival by type of VT Kaplan-Meier estimates of conditional survival in patients with different visceral thromboses.
See this image and copyright information in PMC

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