The safety of anticoagulant therapy in the treatment of splanchnic vein thrombosis associated with acute pancreatitis
- PDF / 541,785 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 59 Downloads / 181 Views
IM - COMMENTARY
The safety of anticoagulant therapy in the treatment of splanchnic vein thrombosis associated with acute pancreatitis Omri Cohen1,2,3 · Walter Ageno3 Received: 11 January 2020 / Accepted: 2 April 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Acute pancreatitis (AP) is associated with significant morbidity, and has an annual incidence ranging from 13 to 45 per 100,000 persons [1]. It represents an important indication for hospital admission worldwide [2−4], and has a mortality rate of 1–7% which increases up to 10–28% in patients with severe AP [3−5]. The inflammation of the pancreas may be associated with a systemic inflammatory response syndrome that can lead to organ dysfunction and progress to organ failure [2]. The presence of inflammation, fluid collection, necrosis and infection can instigate both thrombotic and hemorrhagic complications [6−7]. Splanchnic vein thrombosis (SVT), that is thrombosis of the portal, mesenteric, and/or splenic veins, is an increasingly recognized complication of AP [7−12]. The reported incidence of SVT in patients with AP varies among studies, and ranges from 1.8% [13] to 36.5% in necrotizing AP managed in an intensive care unit [14]. Gonzelez and colleagues previously reported a 15.7% incidence of pancreatitis-induced SVT in 127 patients with AP [15]. In this prospective study, 19 of the 20 patients with thrombosis had peripancreatic collections, which also provided further support to splanchnic vein thrombosis more commonly complicating the clinical course of severe AP rather than mild AP [15]. A systematic review and metaanalysis by Butler and colleagues reported a higher incidence of SVT in AP, 22.6%, among three case series of AP [16]. The true incidence of SVT in unselected AP patients remains unclear. * Omri Cohen [email protected] 1
National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel‑Hashomer, Israel
2
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
3
Department of Medicine and Surgery, University of Insubria, Varese, Italy
The American College of Chest Physicians EvidenceBased Clinical Practice Guidelines recommend anticoagulant treatment in patients with symptomatic SVT, and suggest withholding anticoagulant treatment in patients with incidentally detected SVT, irrespective of the presence of underlying risk factors such as AP [17]. There is no consensus, however, with regard to anticoagulant treatment in patients with SVT associated with AP. Symptoms of SVT frequently overlap with those of AP and SVT may be diagnosed by imaging studies along the course of AP workup [18]. AP guidelines do not specifically address the topic of AP associated SVT [19−21], and data regarding the role of anticoagulant treatment are limited. Anticoagulant treatment was found to improve rates of recanalization and prevent recurrent thrombosis in both cirrhotic [22] and non-cirrhotic [23−26] patients with SVT, with some coinciding increase in bleeding com
Data Loading...
