S1363 Outcomes of Thrombolysis and Thrombectomy in Malignancy-Induced Splanchnic Vein Thrombosis: A Systematic Review and Meta-Analysis

Introduction: Splanchnic vein thrombosis (SVT) is characterized by blood clot formation in the splanchnic venous system. In malignancy, SVT assumes particular clinical significance as cancer patients face a substantially elevated risk. Aggressive interventional approaches have been utilized, like catheter-directed thrombolysis and mechanical thrombectomy. To evaluate the efficacy, safety, and long-term outcomes of thrombolysis and thrombectomy interventions for managing malignancy-induced splanchnic vein thrombosis (SVT). Methods: An all-inclusive search was conducted via PubMed, Cochrane Library, Wiley Online Library, ScienceDirect, EBSCO Open Research, and Google Scholar for research articles on the outcomes of thrombolysis and thrombectomy interventions for managing malignancy-induced SVT. The potential articles were screened against prespecified eligibility criteria. The risk of bias in the eligible studies was then evaluated using the Newcastle Ottawa Scale (NOS). Data were then procedurally extracted and analyzed. Results: Twelve cohort studies were included in this analysis for 7822 patients. Thrombolysis/thrombectomy interventions significantly reduced portal vein thrombosis progression (RD -0.64, 95% CI: -0.79 to -0.50) and mortality (RR 0.23, 95% CI: 0.16 to 0.35, P < 0.00001) in malignancy-induced SVT compared to conventional management. While recanalization rates trended higher with interventional approaches (RR 7.72, 95% CI: 0.24 to 243.25), this finding was not statistically significant (P = 0.25) with considerable heterogeneity (I² = 93%). Intervention groups demonstrated significantly lower bleeding complications (RR 0.18, 95% CI: 0.09 to 0.36, P < 0.00001). Long-term outcomes varied by approach, with combined transjugular thrombectomy/thrombolysis achieving 88.2% secondary patency at 2-year follow-up. Conclusion: Thrombolysis/thrombectomy interventions offer significant benefits for malignancy-induced SVT, demonstrating reduced mortality and thrombosis progression compared to anticoagulation alone, with lower bleeding rates. However, technique-specific outcomes varied substantially, with mechanical and transjugular approaches showing promising durability.