Noor J Sissingh1, Jesse V Groen2, Dylan Koole2, Frederikus A Klok3, Bas Boekestijn4, Thomas L Bollen5, Hjalmar C van Santvoort6, Robert C Verdonk7, Bert A Bonsing2, Casper H J van Eijck8, Jeanin E van Hooft9, J Sven D Mieog10. 1. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands. Electronic address: n.j.sissingh@lumc.nl. 2. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 3. Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands. 4. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands. 6. Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center, Utrecht, the Netherlands. 7. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands. 8. Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. 9. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands. 10. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: J.S.D.Mieog@lumc.nl.
Abstract
OBJECTIVES: The optimal management of patients with acute pancreatitis (AP) and splanchnic vein thrombosis (SVT) remains unknown. This systematic review and meta-analysis aimed to see if therapeutic anticoagulation (AC) improves outcomes in patients with AP and SVT. METHODS: A systematic review was performed according to PRISMA guidelines. Main outcomes were recanalization, recurrent venous thromboembolism, development of varices, collaterals or cavernoma, haemorrhage and mortality. Meta-analysis were performed with the Mantel-Haenszel random effect models. RESULTS: Seven retrospective cohort studies (3495 patients) were included. SVT occurred in 233 (7%) patients and involved most frequently the splenic vein (44%). Therapeutic AC was administered to 109 (47%) patients, most frequently to those with triple vessel thrombosis (72%) and least to those with isolated splenic vein (22%) or superior mesenteric vein thrombosis (0%). Most studies administered (low molecular weight) heparin followed by warfarin (duration ranged between 1.5 and 12 months). This meta-analysis showed an absolute risk difference of 9% (95% confidence interval [CI] = -11-28%) for recanalization, -3% (95% CI = -19-12%) for the development of varices, collaterals or cavernoma, 3% (95% CI = -6-12%) for haemorrhage and 2% (95% CI = -8-12%) for mortality. CONCLUSIONS: Based on the currently available data, it remains unclear if therapeutic anticoagulation provides benefit to acute pancreatitis patients with splanchnic vein thrombosis. These results are based on low quality data underlining the need for further higher quality studies.
OBJECTIVES: The optimal management of patients with acute pancreatitis (AP) and splanchnic vein thrombosis (SVT) remains unknown. This systematic review and meta-analysis aimed to see if therapeutic anticoagulation (AC) improves outcomes in patients with AP and SVT. METHODS: A systematic review was performed according to PRISMA guidelines. Main outcomes were recanalization, recurrent venous thromboembolism, development of varices, collaterals or cavernoma, haemorrhage and mortality. Meta-analysis were performed with the Mantel-Haenszel random effect models. RESULTS: Seven retrospective cohort studies (3495 patients) were included. SVT occurred in 233 (7%) patients and involved most frequently the splenic vein (44%). Therapeutic AC was administered to 109 (47%) patients, most frequently to those with triple vessel thrombosis (72%) and least to those with isolated splenic vein (22%) or superior mesenteric vein thrombosis (0%). Most studies administered (low molecular weight) heparin followed by warfarin (duration ranged between 1.5 and 12 months). This meta-analysis showed an absolute risk difference of 9% (95% confidence interval [CI] = -11-28%) for recanalization, -3% (95% CI = -19-12%) for the development of varices, collaterals or cavernoma, 3% (95% CI = -6-12%) for haemorrhage and 2% (95% CI = -8-12%) for mortality. CONCLUSIONS: Based on the currently available data, it remains unclear if therapeutic anticoagulation provides benefit to acute pancreatitis patients with splanchnic vein thrombosis. These results are based on low quality data underlining the need for further higher quality studies.
Authors: Hannah McMurry; Jean M G Sabile; Benjamin Elstrott; Boris Chobrutskiy; Ajay Mohinani; Sarah Patel; Sonia Gowda; Kylee Martens; Joseph Shatzel Journal: Thromb Res Date: 2022-05-27 Impact factor: 10.407