Archives of Hellenic Medicine

Last update:

06-Dec-2017

Arch Hellen Med, 34(6), November-December 2017, 771-789

REVIEW

Venous thrombosis in unusual sites: The hematological approach

A. Bouchla, ^1,2 Ε. Grouzi,^2,3 E. Kyriakou,⁴ Ε. Lada,⁴ Α.Travlou,^2,5 V. Pappa,^1,2 S.I. Kokoris^2,4
¹Second Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens,
²Postgraduate Program (MSc) "Thrombosis-Bleeding-Transfusion medicine", School of Medicine, National and Kapodistrian University of Athens, Athens,
³Transfusion Service and Department of Clinical Hemostasis, "Saint Savvas" Oncology Hospital, Athens,
⁴Laboratory of Hematology and Blood Bank Unit, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens,
⁵Laboratory of Thrombosis, Bleeding Disorders, and Anticoagulation Monitoring, Medical Center of Psychico, Athens, Greece

The venous system and its anatomical variations are complex, and thrombosis may take place at practically any site. The sites of greatest clinical relevance are splanchnic vein thrombosis, and in particular portal vein thrombosis and the Budd-Chiari syndrome, cerebral vein, inferior vena cava and upper extremity deep vein thrombosis. Other unusual sites of thrombosis include the retinal vein, internal jugular vein, branchionocephalic and upper vena cava, mesenteric and splenic vein, iliac vein, renal vein, ovarian vein and dorsal penal vein. Venous thrombosis in unusual places constitutes a challenge for the hematologist as each thrombosis site has different characteristics regarding epidemiology, etiopathogenesis, clinical manifestations, therapeutic treatment and prognosis. The understanding of localized and systemic thrombophilic factors and their relationship with familial or acquired thrombophilia is a complicated process requiring close cooperation between the hematologist and the relevant clinicians. Lack of randomized controlled trials has led to heterogeneity in the decisions regarding initiation of treatment and drug choices. This review provides current practical guidance on investigation and treatment of patients with venous thrombosis in unusual sites.

Key words: Splanchnic, Cerebral vein thrombosis, Thrombophilia, Unusual venous thrombosis.