https://www.um.edu.mt/library/oar/handle/123456789/485 Tue, 16 Jun 2026 20:32:48 GMT 2026-06-16T20:32:48Z https://www.um.edu.mt/library/oar/handle/123456789/147440 Title: Renal vein thrombosis : a narrative review Authors: Riva, Nicoletta; Gatt, Alexander; Gauci, Maria Angela; Roberts, Lara; Thachil, Jecko; Borg-Xuereb, Christian Abstract: Renal venous thrombosis (RVT) is a location of unusual-site venous thromboembolism. RVT occurs more commonly in males, and shows a bimodal age distribution, with a neonatal and adult peak. Abdominal malignancies and nephrotic syndrome are prominent risk factors in adults, whereas hypotension, birth asphyxia, sepsis, umbilical venous catheters and prematurity are the predominant causes in children. The most common symptoms of RVT include abdominal pain and macroscopic haematuria. A palpable abdominal mass is often observed in neonates, while antenatal RVT may present with signs of foetal distress. Bilateral RVT can lead to acute renal failure. Anticoagulation is the cornerstone of treatment, traditionally with unfractionated heparin, low molecular weight heparin and vitamin K antagonists, although recent evidence is emerging on the use of the direct oral anticoagulants in selected RVT patients. Endovascular procedures (e.g., local thrombolysis or mechanical thrombectomy) are usually reserved for more severe cases, such as bilateral acute RVT causing kidney dysfunction. Outcome data show variability in mortality rates, with some adult cohorts reporting high mortality linked to underlying malignancies and other comorbidities. In paediatric cohorts, mortality is low, but RVT can lead to long-term complications, including kidney atrophy, kidney dysfunction and hypertension. This narrative review aims to synthesise the current evidence on RVT, with a particular focus on anticoagulant prophylaxis and treatment, and clinical outcomes in adult and paediatric populations. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/147440 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/147439 Title: Splanchnic vein thrombosis with and without myeloproliferative neoplasms : a comparative cohort study Authors: Ko, Amica K.; Milana, Laura; Riva, Nicoletta; Bertu, Lorenza; Bertoletti, Laurent; Beyer-Westendorf, Jan; Carrier, Marc; Delluc, Aurelien; Grandone, Elvira; Kamphuisen, Pieter; Lazo-Langner, Alejandro; Maffioli, Margherita; Poli, Daniela; Schulman, Sam; Senzolo, Marco; Testa, Sophie; Tosetto, Alberto; Verhamme, Peter; Leebeek, Frank W. G.; Darwish Murad, Sarwa; Ageno, Walter; Lauw, Mandy N. Abstract: Background: Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism but relatively common in patients with myeloproliferative neoplasms (MPNs). Studies on management and outcomes for patients with MPN-SVT, including comparisons with non-MPN-SVT, are scarce. Objectives: We assessed anticoagulant management and recurrent thrombosis, bleeding, and survival outcomes in SVT patients with and without MPN. Methods: We conducted a multicenter comparative cohort study in adults with SVT using individual patient data from 3 published studies and 2 hospital cohorts. Anticoagulant management after SVT diagnosis was evaluated; 6-month cumulative incidences of recurrent thrombosis, bleeding, and death were calculated. We used propensity score weighting to compare outcomes between patients with and without MPN. A subanalysis excluding patients with cirrhosis or solid cancer was performed. Results: We investigated 1189 patients with SVT, 187 with underlying MPN. Anticoagulation was started in 76.1% of patients within 30 days after SVT diagnosis, 78.6% were still anticoagulated at 6 months; this was similar between patients with and without MPN. The 6-month cumulative incidence of recurrent thrombosis and bleeding was 2.5% and 4.5%, respectively. Overall survival was 93.7% at the 6-month follow-up. No significant differences were observed in clinical outcomes between patients with and without MPN, also confirmed by subanalyses. Conclusion: In this large cohort, incidences of recurrent thrombosis, bleeding and survival 6 months after SVT were similar in patients with and without MPN. This suggests that MPN-related SVT could be regarded similarly to noncirrhotic, nonmalignant SVT for anticoagulant management and outcomes. Prospective studies with long-term follow-up are still needed for MPN-related patients with SVT. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/147439 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/147233 Title: Treatment strategies, bleeding, long-term recurrence and mortality in abdominal vein thrombosis : findings from the TROLL registry Authors: Jørgensen, Camilla Tøvik; Riva, Nicoletta; Pettersen, Heidi Hassel; Frønæs, Synne; Ghanima, Waleed; Tavoly, Mazdak Abstract: Background: Abdominal vein thrombosis (AVT) is an uncommon manifestation of venous thromboembolism (VTE). Data pertaining to management and the clinical course of AVT are limited.; Objectives: To investigate anticoagulant treatment strategies, bleeding complications, recurrence, and all-cause mortality among patients with AVT.; Methods: From January 2005 to December 2024, 241 patients with objectively confirmed isolated AVT were identified from The Venous Thrombosis Registry in ØstfOLd HospitaL (TROLL), Norway. Bleeding events were categorized as major bleeding (MB) or clinically relevant non-major bleeding (CRNMB) during anticoagulant treatment, and recurrent events were assessed after anticoagulant treatment discontinuation. Cumulative incidences of bleeding and recurrent events were estimated using the Fine-Gray subdistribution hazard model, accounting for the competing risk of death.; Results: Among 241 patients, 117 (48.6%) were women, median age was 61 (IQR: 49-71), and 86 (35.7%) had solid cancer. The portal vein was most frequently affected (n = 93, 38.6%), and 14 (5.8%) had liver cirrhosis. Overall, 237 (98.3%) received anticoagulant treatment; 150 (63.3%) with direct oral anticoagulants (DOACs) and 75 (31.7%) with low-molecular weight heparins (LMWHs). The 6-month cumulative incidence of MB was 3.4% (95% CI: 1.6-6.3) and of CRNMB 6.7% (95% CI: 3.8-10.3). Seven of 8 MB and eight of 15 CRNMB events occurred with LMWH treatment. The 5-year cumulative incidence of VTE recurrence after anticoagulant discontinuation was 9.6% (95% CI, 4.6-16.8).; Conclusion: Most patients were treated with DOACs. The incidence of MB and CRNMB was low. While the overall recurrence rate was also low, the upper-bound of CI indicates a non-negligible risk. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/147233 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146720 Title: Prescribing patterns and clinician preferences for direct oral anticoagulant use in unusual site venous thromboembolism : a cross-sectional analysis from the Direct oral anticoagulants in Unusual Site venous Thromboembolism (DUST) study Authors: Riva, Nicoletta; Bertoletti, Laurent; Chistolini, Antonio; De Stefano, Valerio; Barbar, Sofia; Donadini, Marco Paolo; Sartori, Maria Teresa; Couturaud, Francis; Sartori, Michelangelo; Gatt, Alexander; Cohen, Omri; Fantoni, Chiara; Kaatz, Scott; Mavri, Alenka; Mahé, Isabelle; Catella, Judith; Ruiz-Artacho, Pedro; Ghigliotti, Giorgio; Jara-Palomares, Luis; Podda, Gian Marco; Squizzato, Alessandro; Rojnuckarin, Ponlapat; Leentjens, Jenneke; Sevestre, Marie Antoinette; Ageno, Walter Abstract: Background: Unusual site venous thromboembolism (USVTE) presents therapeutic challenges. Direct oral anticoagulants (DOACs) are increasingly prescribed despite limited evidence from clinical trials. Objectives: This cross-sectional analysis aimed to describe DOAC prescription patterns and rationale for choosing DOACs for USVTE treatment in real-life clinical practice. Methods: The Direct oral anticoagulants in Unusual Site venous Thromboembolism study (NCT03778502) is an international, multicenter, prospective, observational registry. Adult patients with objectively diagnosed USVTE (years 2018-2023) treated with DOACs were included. Information was collected on patient characteristics, USVTE location, anticoagulant treatment, and rationale for starting DOACs. Results: In total, 349 patients were included from 23 centers in 9 countries. The most common USVTE were splanchnic vein thrombosis (n = 219, 62.8%) and cerebral vein thrombosis (n = 103, 29.5%). The most prescribed DOACs were apixaban (n = 186, 53.3%) and rivaroxaban (n = 101, 28.9%). The median delay between USVTE diagnosis and DOAC initiation was 24 days, with 219 patients (62.8%) starting DOACs >14 days after diagnosis. Indeed, 320 (91.7%) patients received other anticoagulants before switching to DOACs (mainly low-molecular-weight heparin, n = 217, 67.8%). The main reasons for prescribing DOACs were oral administration (145/336, 43.2%), no need for blood monitoring (131/336, 39.0%), favorable safety profile (116/336, 34.5%), and prescriber-reported patient's preference (96/336, 28.6%). Apixaban was the most prescribed DOAC in splanchnic vein thrombosis (133/219, 60.7%), while dabigatran was the most prescribed DOAC in cerebral vein thrombosis (38/103, 36.9%). Conclusion: DOACs are increasingly prescribed for USVTE owing to their ease of use and perceived safety, but mainly after initial treatment with parenteral anticoagulation. Further evidence is still needed to support their use in the acute phase. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146720 2026-01-01T00:00:00Z