Incidence and Outcomes of Splanchnic Vein Thrombosis in Patients with Pancreatitis

Pavankumar Kamat

Disclosures

November 03, 2021

Takeaway

  • The incidence of splanchnic vein thrombosis (SVT) remains significant in patients with acute pancreatitis.

  • Treatment with anticoagulants improved the rate of recanalisation but increased the risk of haemorrhagic complications, without increasing overall mortality.

Why this matters

  • There is a scarcity of high-quality research examining the use of anticoagulation regimens and the overall outcomes of patients who develop SVT because of acute pancreatitis.

Study design

  • UK researchers conducted a systematic review and meta-analysis of 18 studies (15 retrospective; 3 prospective), identified through a search across electronic databases.

  • Primary outcome: overall incidence of SVT in patients with acute pancreatitis and incidence of SVT at first presentation of acute pancreatitis.

  • Secondary outcomes: recanalisation in anticoagulation-treated vs untreated patients, haemorrhagic complications and incidence of portal hypertension and mortality.

  • Funding: Medical Research Council and Arthritis Research UK.

Key results

  • A total of 943 patients with acute pancreatitis were diagnosed with SVT, of whom 264 (28.0%) patients received therapeutic anticoagulation.

  • The overall incidence of SVT in patients with acute pancreatitis was 17% (95% CI, 14-20%; I2, 98.20%) and the pooled incidence of SVT at first presentation of acute pancreatitis was 15% (95% CI 5 to 26%).

  • Recanalisation of the thrombosed vein was more likely to occur in anticoagulation-treated patients with acute pancreatitis vs anticoagulation-untreated patients with acute pancreatitis (OR, 0.51; 95% CI, 0.31-0.83; P=.007).

  • The anticoagulated group was also more likely to develop haemorrhagic complications (Risk ratio [RR],  2.27; 95% CI, 0.81-6.37; P=.12), but the risk of overall mortality did not increase (RR, 2.37; 95% CI, 0.86-6.52; P=.10).

  • The overall incidence of portal hypertension in patients with acute pancreatitis was 60% (95% CI, 55-65%).

Limitations

  • Heterogeneity among studies.

  • Risk of bias.

 

Anis FS, Adiamah A, Lobo DN, Sanyal S. Incidence and Treatment of Splanchnic Vein Thrombosis in Patients with Acute Pancreatitis: A Systematic Review and Meta-analysis. J Gastroenterol Hepatol. 2021 Oct 17 [Epub ahead of print]. doi: 10.1111/jgh.15711. PMID: 34657310  View abstract  

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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