Anticoagulation for splanchnic vein thrombosis in acute pancreatitis increases bleeding risk without improving outcomes

Abstract

Background/objectives

Treatment guidelines on anticoagulation (AC) to treat splanchnic vein thrombosis (SVT) after acute pancreatitis (AP) are not well-established. This research examines the efficacy and safety of AC in SVT.

Methods

We retrospectively investigated the demographics, clinical progression, radiologic findings, interventions, and outcomes of patients with AP between 2018 and 2022 at a single tertiary care center. The primary and secondary outcomes were development of SVT in AP and effects of AC, respectively.

Results

897 patients developed AP (average 50.5 years old, 46% female, 20% moderately severe AP, 4% severe AP), of whom 4.8% developed SVT. SVT was associated with recurrent and chronic pancreatitis (28%, p = 0.021 and 37%, p < 0.001) and malignancy (21%, p < 0.001). SVT was associated with severe pancreatitis courses (12% vs. 3%, p < 0.001) and an increase in six-month mortality (14% vs. 4%, p = 0.022). AC was used for 47% of patients with SVT. However, AC did not prevent SVT sequelae, including gastroesophageal varices formation (p = 1), variceal hemorrhage (p = 0.68), or splenic infarction (p = 1), and did not improve survival (p = 0.19). While AC did not improve outcomes, it was associated with bleeding episodes in 50% of patients (p < 0.001).

Conclusions

Approximately half of patients who develop SVT after AP receive AC despite no reduction in adverse events or mortality. Additionally, half of patients receiving AC experience bleeding complications. The limited evidence presented in this study suggests that the risks of AC for SVT in AP may outweigh its benefits and highlights the need for future studies in larger prospective cohorts.