SP2.09 ‘Stop the clot’ - A standardised approach to managing splanchnic vein thrombosis in the acute surgical patient

Introduction The incidence and prevalence of splanchnic vein thrombosis (SVT) is rising in acute surgical patients (2.7/100,000). Risk factors include malignancy, surgery, abdominal inflammation/infection and HRT. Management strategies are variable and high-quality data and guidelines limited. Aims To determine the incidence and current management of SVT’s in patients presenting with Emergency General Surgery pathology To develop an evidence based, standardized pathway for the management of this condition with a focus on anticoagulation choice, duration and re-imaging options Methods A prospective cohort study was undertaken for 1 year. Patients over 16 presenting to an EGS service with an acute inflammatory abdominal condition and acute SVT were included. Data was collected and analysed in Microsoft Excel. Results 25 patients were included. 22 (88%) were provoked and 3 (12%) unprovoked. 21 (84%) received treatment. Primary choice of anticoagulation was LMWH 10 (47%), Warfarin 8 (38%) and DOAC 3 (15%). 7 (33%) of patients had no decision made regarding the duration of anticoagulation treatment. 6 (29%) received follow-up cross-sectional imaging to assess for resolution/vessel. 9 (45%) patients received clinic follow up. 2 (8%) patient demonstrated thrombosis resolution. Conclusion Current practice demonstrates wide variation and inconsistencies in the management of acute SVT. Stakeholders include Surgeons, Haematologist’s and Radiologists and a subsequent structured iterative collaboration was undertaken to develop a standardised pathway. Management now includes primary DOAC for 6-months, follow up CT to assess for re-canalisation. Patients should be followed up thereafter in clinic to outline ongoing management strategies.