Efficacy and Safety of Early Systemic Anticoagulation for Preventing Splanchnic Thrombosis in Acute Necrotizing Pancreatitis.
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
9
9
2020
medline:
10
8
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 32898006
doi: 10.1097/MPA.0000000000001661
pii: 00006676-202010000-00014
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1220-1224Références
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 suppl 2):e1–e15.
Mallick IH, Winslet MC. Vascular complications of pancreatitis. JOP. 2004;5:328–337.
Mortelé KJ, Mergo PJ, Taylor HM, et al. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol. 2004;52:67–72.
Dörffel T, Wruck T, Rückert RI, et al. Vascular complications in acute pancreatitis assessed by color duplex ultrasonography. Pancreas. 2000;21:126–133.
Gonzelez HJ, Sahay SJ, Samadi B, et al. Splanchnic vein thrombosis in severe acute pancreatitis: a 2-year, single-institution experience. HPB (Oxford). 2011;13:860–864.
Zhou J, Ke L, Tong Z, et al. Risk factors and outcome of splanchnic venous thrombosis in patients with necrotizing acute pancreatitis. Thromb Res. 2015;135:68–72.
Ding L, Deng F, Yu C, et al. Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis. World J Gastroenterol. 2018;24:4054–4060.
Lasson A, Ohlsson K. Consumptive coagulopathy, fibrinolysis and protease-antiprotease interactions during acute human pancreatitis. Thromb Res. 1986;41:167–183.
Lasson A, Ohlsson K. Disseminated intravascular coagulation and antiprotease activity in acute human pancreatitis. Scand J Gastroenterol Suppl. 1986;126:35–39.
Rebours V, Boudaoud L, Vullierme MP, et al. Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia. Am J Gastroenterol. 2012;107:1579–1585.
Nadkarni NA, Khanna S, Vege SS. Splanchnic venous thrombosis and pancreatitis. Pancreas. 2013;42:924–931.
Köklü S, Yüksel O, Arhan M, et al. Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study. Dig Dis Sci. 2005;50:976–982.
Easler J, Muddana V, Furlan A, et al. Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Gastroenterol Hepatol. 2014;12:854–862.
Gotto A, Lieberman M, Pochapin M. Gastric variceal bleeding due to pancreatitis-induced splenic vein thrombosis. BMJ Case Reps. 2014;2014:bcr2013201359.
Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). 2011;13:839–845.
Madsen MS, Petersen TH, Sommer H. Segmental portal hypertension. Ann Surg. 1986;204:72–77.
Park DE, Chae KM. Chylous ascites caused by acute pancreatitis with portal vein thrombosis. J Korean Surg Soc. 2011;81(suppl 1):S64–S68.
Joniau M, Coudijzer K, De Cuyper M. Reaction of alpha-tubulin with iodotyrosines catalyzed by tubulin: tyrosine ligase: carboxy-terminal labeling of tubulin with [125I] monoiodotyrosine. Anal Biochem. 1990;184:325–329.
Das S, Swain SK, Ramamurthy A. Hepatic infarction from portal vein thrombosis: a fatal consequence of acute pancreatitis. J Dig Dis. 2017;18:425–427.
Harris S, Nadkarni NA, Naina HV, et al. Splanchnic vein thrombosis in acute pancreatitis: a single-center experience. Pancreas. 2013;42:1251–1254.
Plessier A, Darwish-Murad S, Hernandez-Guerra M, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 2010;51:210–218.
Maynard G. Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement. 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Publication No. 16-0001-EF.
Tenner S, Baillie J, DeWitt J, et al; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400–1415; 1416.
Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27.
Golemi I, Salazar Adum JP, Tafur A, et al. Venous thromboembolism prophylaxis using the Caprini score. Dis Mon. 2019;65:249–298.
Jiang W, Zhou J, Ke L, et al. Splanchnic vein thrombosis in necrotizing acute pancreatitis: detection by computed tomographic venography. World J Gastroenterol. 2014;20:16698–16701.
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–810.
Besselink MG. Splanchnic vein thrombosis complicating severe acute pancreatitis. HPB (Oxford). 2011;13:831–832.
Ahmed SU, Rana SS, Ahluwalia J, et al. Role of thrombophilia in splanchnic venous thrombosis in acute pancreatitis. Ann Gastroenterol. 2018;31:371–378.
Roach RE, Cannegieter SC, Lijfering WM. Differential risks in men and women for first and recurrent venous thrombosis: the role of genes and environment. J Thromb Haemost. 2014;12:1593–1600.
Toqué L, Hamy A, Hamel JF, et al. Predictive factors of splanchnic vein thrombosis in acute pancreatitis: a 6-year single-center experience. J Dig Dis. 2015;16:734–740.
Severinsen MT, Kristensen SR, Johnsen SP, et al. Smoking and venous thromboembolism: a Danish follow-up study. J Thromb Haemost. 2009;7:1297–1303.
Yan Y, Ji Y, Su N, et al. Non-anticoagulant effects of low molecular weight heparins in inflammatory disorders: a review. Carbohydr Polym. 2017;160:71–81.
Manfredi AA, Rovere-Querini P, D'Angelo A, et al. Low molecular weight heparins prevent the induction of autophagy of activated neutrophils and the formation of neutrophil extracellular traps. Pharmacol Res. 2017;123:146–156.
Ke L, Ni HB, Tong ZH, et al. Efficacy of continuous regional arterial infusion with low-molecular-weight heparin for severe acute pancreatitis in a porcine model. Shock. 2014;41:443–448.
Ranson JH, Lackner H, Berman IR, et al. The relationship of coagulation factors to clinical complications of acute pancreatitis. Surgery. 1977;81:502–511.
Ke L, Ni HB, Tong ZH, et al. D-dimer as a marker of severity in patients with severe acute pancreatitis. J Hepatobiliary Pancreat Sci. 2012;19:259–265.
Cho CW, Park YJ, Kim YW, et al. Follow-up results of acute portal and splenic vein thrombosis with or without anticoagulation therapy after hepatobiliary and pancreatic surgery. Ann Surg Treat Res. 2015;88:208–214.
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.
Qiu Q, Guo Jun L, Tang L, et al. The efficacy of low molecular weight heparin in severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. J Dig Dis. 2019;20:512–522.