Improved Prognosis and Low Failure Rate with Anticoagulation as First-Line Therapy in Mesenteric Venous Thrombosis

The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000–2007) and 3.2% in the latter (2008–2015) part of the study period (p = 0.006). Age ≥75 years (OR 12.4, 95% CI [2.5–60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3–54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2–51.6]) were independently associated with increased mortality in multivariable analysis.