Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3-year single-centre experience

• Published in: Internal and emergency medicine 2020-09, Vol.15 (6), p.1021-1029
• Main Authors: Pagliari, Danilo, Cianci, Rossella, Brizi, Maria Gabriella, Mancarella, Francesco Antonio, Musso, Massimiliano, Cintoni, Marco, Franza, Laura, Flore, Roberto Antonio, Gasbarrini, Antonio, Tondi, Paolo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants; Anticoagulants - pharmacology; Anticoagulants - therapeutic use; Chi-Square Distribution; Clinical trials; Coagulants; Diagnosis; Female; Fondaparinux - pharmacology; Fondaparinux - therapeutic use; Heparin; Humans; Im - Original; Internal Medicine; Italy; Male; Medicine; Medicine & Public Health; Middle Aged; Molecular weight; Pancreas; Pancreatitis; Pancreatitis - complications; Pancreatitis - physiopathology; Patients; Prospective Studies; Retrospective Studies; Splanchnic Circulation - drug effects; Thrombosis; Thrombosis - drug therapy; Vitamin K
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-019-02271-5

Splanchnic vein thrombosis (SVT) is a possible complication of acute pancreatitis (AP). There are no precise guidelines on the use of anticoagulant therapy (AT) in these patients. The aim of the study was to determine the safety and the efficacy of AT in AP-associated SVT. Two hundred twenty-one patients were retrospectively and consecutively enrolled from the Pancreatic Outpatient Clinic of the “A. Gemelli” hospital. Patients had a diagnosis of AP and a diagnostic imaging to evaluate whether they had or not SVT. Twenty-seven out of 221 AP patients had SVT (12.21%) and AT therapy was administered to 16 patients (59.3%), for 5.2 ± 2.2 months. A therapeutic dose of low molecular weight heparin was administered (100 UI/kg b.i.d.) at the diagnosis, with fondaparinux 7.5 mg/day, or vitamin K antagonist, or the novel direct oral anti-coagulants, upon discharge. The presence of SVT resulted significantly associated to male sex ( p  = 0.002). The recanalization rates were 11/16 (68.7%) in patients who received AT, and 3/11 (27.3%) in patients who did not receive it. There was a significant difference between the recanalization rates with and without AT ( p  = 0.03, OR 5.87). No SVT recurrence was registered during follow-up. No treated patient developed haemorrhagic complications after AT. No deaths were recorded, either in the group undergoing AT or in the one that was not. In conclusion, AT in AP-associated SVT appears to be safe and effective; yet prospective clinical trials are needed to confirm our results.