Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A systematic review and meta-analysis

Noor J. Sissingh, Jesse V. Groen, Dutch Pancreatitis Study Group, Dylan Koole, Frederikus A. Klok, Bas Boekestijn, Thomas L. Bollen, Hjalmar C. van Santvoort, Robert C. Verdonk, Bert A. Bonsing, Casper H.J. van Eijck, Jeanin E. van Hooft, J. Sven D. Mieog*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)235-243
Number of pages9
JournalPancreatology
Volume22
Issue number2
DOIs
Publication statusAccepted/In press - 22 Dec 2021

Bibliographical note

Funding Information:
The authors thank J.W. Schoones (Walaeus library, Leiden University Medical Center, Leiden, the Netherlands) for composing the literature search. This research did not receive any specific grant. The authors reports no conflicts of interest in this work.

Publisher Copyright:
© 2021 The Authors

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