Long-term antithrombotic therapy in patients with short bowel syndrome: A European Society for Clinical Nutrition and Metabolism (ESPEN) position paper.

BACKGROUND AND AIMS: Recommendations on anticoagulation in patients with short bowel syndrome (SBS) following acute mesenteric ischaemia (AMI) or complicated by catheter-related thrombosis (CRT), are limited. Guidance is specifically lacking on antithrombotic drug selection, dosing, treatment duration and monitoring. Moreover, current recommendations do not account for the potentially impaired drug absorption in patients with SBS. This multidisciplinary position paper aims to develop a practical management guide for antithrombotic therapy in patients with SBS following AMI, as well as CRT. METHODS: Nineteen intestinal failure experts, coagulation specialists, and clinical pharmacists completed a three-round Delphi voting procedure on 52 initial statements regarding antithrombotic drug and dose selection, duration and monitoring of treatment and testing for underlying diseases in case of AMI. RESULTS: After three voting rounds, 46 statements were retained with good agreement (i.e., >80%) for 38 of them, moderate agreement (i.e., >70-80%) for two statements, and low agreement (i.e., ≤70%) for the remaining six. CONCLUSIONS: While robust evidence is lacking regarding antithrombotic therapy in patients with SBS, consensus was reached on the majority of statements. More research in this field is required, particularly on oral drug absorption in SBS, development of alternative oral drug formulations, treatment strategies following arterial mesenteric stenting and direct oral anticoagulant (DOAC) dosing for secondary prophylaxis of CRT in SBS.