Indefinite anticoagulation with reduced-intensity direct oral anticoagulants in patients with splanchnic vein thrombosis. An international practice survey

Abstract

Introduction: Low-dose direct oral anticoagulants (DOACs) could be beneficial for secondary prevention of splanchnic vein thrombosis (SVT) in subgroups of patients at high risk for recurrence. In the absence of direct evidence, we aimed to identify the practice preferences of physicians managing patients with SVT in an international web-based survey.

Methods and results: An anonymous questionnaire was sent via E-Mail between April and July 2023 to members of 14 national and international scientific societies. We received 236 responses of which 175 were complete responses. After an initial 3-6 months of SVT treatment, more than 80% of respondents would continue anticoagulation in the presence of cancer, myeloproliferative neoplasms, or in case of unprovoked SVT. If anticoagulation is continued, 45.8-68.6% would use reduced-intensity dosing of DOACs. In case of compensated cirrhosis or controlled inflammatory bowel disease (IBD), 54.3% and 44.4% of respondents would continue anticoagulation and 68.8% and 73.3% would opt for reduced-intensity DOAC dosing, respectively. Gastroenterologists were more likely to discontinue anticoagulation in SVT associated with cancer, controlled IBD, or unprovoked event, and more likely to continue anticoagulation in compensated cirrhosis compared to other specialists. Overall, 96% of respondents supported prospective evaluation of low-dose DOACs for the secondary prevention of SVT.

Conclusion: This survey showed that physicians adapt duration and intensity of anticoagulation therapy depending on the patient's specific condition and risk factors even in the absence of high-quality evidence. Prospective evaluation is awaited.