Introduction: Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk.Case presentation: We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization.Conclusions: Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

Lung cancer is strongly associated with a hypercoagulable state, significantly increasing the risk of venous thromboembolism (VTE) and complicating clinical management. The mechanisms underlying cancer-associated coagulopathy are multifactorial, involving tumor-derived procoagulants, chronic inflammation, endothelial dysfunction, autoim-mune phenomena, and treatment-induced effects. These processes not only drive throm-bosis but also influence disease progression and therapeutic decisions. Moreover, the presence of antiphospholipid antibodies and acquired inhibitors of coagulation adds fur-ther complexity by simultaneously predisposing patients to both thrombosis and bleed-ing. This review provides a clinically oriented synthesis of the current evidence on coagu-lation abnormalities in lung cancer, highlighting diagnostic strategies—including mixing studies and biomarker evaluation—and exploring treatment approaches such as low-molecular-weight heparins, direct oral anticoagulants, and immunosuppressive regimens. Recognizing and managing coagulation disorders is essential for optimizing outcomes in lung cancer patients, and a multidisciplinary, personalized approach is in-creasingly warranted in oncologic practice.