Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3-year single-c
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Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3‑year single‑centre experience Danilo Pagliari1,4 · Rossella Cianci2 · Maria Gabriella Brizi3 · Francesco Antonio Mancarella1 · Massimiliano Musso1 · Marco Cintoni1 · Laura Franza2 · Roberto Antonio Flore4 · Antonio Gasbarrini1 · Paolo Tondi4 Received: 8 October 2019 / Accepted: 23 December 2019 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract 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. Keywords Splanchnic vein thrombosis · Acute pancreatitis · Anticoagulant therapy · Pancreatic collections
Introduction Splanchnic vein thrombosis (SVT) is a complication of acute pancreatitis (AP) [1, 2]. It can involve one or more veins, such as portal (PV), splenic (SV) or superior mesenteric vein * Danilo Pagliari [email protected] 1
Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli‑IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
2
Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli‑IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
3
Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli‑IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
4
Internal Medicine and Angiology, Fondazione Policlinico Universitario A. Gemelli‑IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
(SMV). SVT can be symptomatic, but it can also be silent and diagn
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