The correct answer: is 3.
Thromboembolism occurs one in every five patients with myeloproliferative neoplasms (MPNs). The incidence of splanchnic vein thrombosis (SVT) in patients varies and can affect mortality and morbidity. Active gastrointestinal bleeding occurring as a result of portal hypertension and or with anticoagulant therapy in these patients requires immediate stabilization and control of the bleeding source. The timing of anticoagulation resumption or initiation must account for hemostasis, rebleeding risk, thrombus extent and progression, and the patient's overall clinical condition. Cytoreductive therapy does not replace anticoagulation when anticoagulation is indicated. Long-term anticoagulation is frequently needed due to the risk of recurrent thrombosis and the other risk factors for thrombosis. Discontinuing anticoagulation can still be a difficult decision. There is no universally applicable time point for restarting anticoagulation after acute variceal bleeding in every patient with MPN-SVT. The decision requires multidisciplinary assessment, often involving hematology, hepatology and gastroenterology.
References:
1. Demirci U, Baysal M, Aksoy E, et al. Evaluation of the frequency, risk factors, and outcomes of splanchnic vein thrombosis in myeloproliferative neoplasms: a retrospective cohort study. J Thromb Thrombolysis. 2026 Aug 7. doi: 10.1007/s11239-026-03363-8.
2. Baysal M, Bayrak M, Eşkazan AE. Current evidence on the use of direct oral anticoagulants in patients with myeloproliferative neoplasm: a systematic review. Expert Rev Hematol. 2023 Feb;16(2):131-140.
3. How C, Chrysafi P, Ko A, et al. Anticoagulation Management of Splanchnic Vein Thrombosis in Myeloproliferative Neoplasms: A Global Abdominal/Splanchnic Thrombosis Retrospective Observational Study in 486 MPN Patients (GASTRO-MPN). Blood. Volume 144, 2024, Page 16.
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