Jing Zhou1, He Zhang2, Wenjian Mao3, Lu Ke1, Gang Li1, Bo Ye1, Jingzhu Zhang1, Jiajia Lin1, Lin Gao1, Zhihui Tong1, Weiqin Li1. 1. From the Center of Severe Acute Pancreatitis, Jinling Hospital, School of Medicine, Nanjing University. 2. Center of Severe Acute Pancreatitis, Jinling Hospital, Southeast University School of Medicine. 3. Center of Severe Acute Pancreatitis, Jinling Hospital, School of Medicine, Nanjing Medical University, Nanjing, China.
Abstract
OBJECTIVES: Splanchnic venous thrombosis (SVT) is a relevant complication in patients with acute necrotizing pancreatitis. So far, no specific treatment for preventing development of SVT exists, and the effect of systemic anticoagulation (SAC) is unclear. METHODS: Patients with acute necrotizing pancreatitis admitted to our center within 7 days from onset of abdominal pain were screened. In the historic group, during which period, most patients received no SAC. Patients in the study group received SAC therapy considering the risk of deep vein thrombosis and SVT. The primary outcome measure was the incidence of SVT. RESULTS: Splenic vein was involved in 71% of all 84 SVT patients. Compared with the historic cohort, patients who received SAC experienced lower incidence of SVT (P < 0.001), especially for splenic venous thrombosis (P = 0.002). Patients in the study group also showed lower mortality (P = 0.04) and incidence of new-onset organ failure (P = 0.03). The incidence of bleeding shows no statistical significance between 2 groups. CONCLUSIONS: Application of SAC seems to reduce the incidence of SVT and improve clinical outcomes without increasing the risk of bleeding. Randomized clinical trials are needed to confirm our findings.
OBJECTIVES:Splanchnic venous thrombosis (SVT) is a relevant complication in patients with acute necrotizing pancreatitis. So far, no specific treatment for preventing development of SVT exists, and the effect of systemic anticoagulation (SAC) is unclear. METHODS:Patients with acute necrotizing pancreatitis admitted to our center within 7 days from onset of abdominal pain were screened. In the historic group, during which period, most patients received no SAC. Patients in the study group received SAC therapy considering the risk of deep vein thrombosis and SVT. The primary outcome measure was the incidence of SVT. RESULTS: Splenic vein was involved in 71% of all 84 SVT patients. Compared with the historic cohort, patients who received SAC experienced lower incidence of SVT (P < 0.001), especially for splenic venous thrombosis (P = 0.002). Patients in the study group also showed lower mortality (P = 0.04) and incidence of new-onset organ failure (P = 0.03). The incidence of bleeding shows no statistical significance between 2 groups. CONCLUSIONS: Application of SAC seems to reduce the incidence of SVT and improve clinical outcomes without increasing the risk of bleeding. Randomized clinical trials are needed to confirm our findings.
Authors: Saurabh Chandan; Avanija Buddam; Shahab R Khan; Babu P Mohan; Daryl Ramai; Mohammad Bilal; Banreet Dhindsa; Neil Bhogal; Lena L Kassab; Hemant Goyal; Abhilash Perisetti; Antonio Facciorusso; Douglas G Adler Journal: Ann Gastroenterol Date: 2021-09-14