Approach to thrombophilia testing in patients with splanchnic vein thrombosis
Splanchnic vein thrombosis is an uncommon yet potentially morbid clinical entity. Many clinical factors are associated with splanchnic vein thrombosis including local precipitating factors, myeloproliferative neoplasms (MPNs), paroxysmal nocturnal hemoglobinuria (PNH), and both inherited and acquired thrombophilias. Recommendations for thrombophilia testing in these patients are varied. Data and practices relevant to deep venous thrombosis and pulmonary embolism are often extrapolated to aid in management of splanchnic vein thrombosis even though the underlying predisposing factors and pathophysiology of these entities may be different. In the February 2017 issue of Best Practice & Research Clinical Gastroenterology, Zarrouk and colleagues report their results of a single-center retrospective study assessing the prevalence of risk factors in 120 patients hospitalized with mesenteric venous thrombosis (MVT), with a systematic review of the literature regarding thrombophilia prevalence and testing in this population. We review their findings and offer a rational approach to thrombophilia testing in patients with splanchnic vein thrombosis using the best available evidence.