Impact of low-molecular-weight heparin in the treatment of moderately severe and severe acute pancreatitis; a randomized, single blind, phase 3 control trial

Patil, Basavaraj; Meena, Laxmi Narayan; Sharma, Dinesh C; Agarwal, Garima; Dhadhich, Yogendra; Gupta, Gaurav

doi:10.1016/j.ijsu.2022.106621

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…Notably, low-molecular-weight heparin was found to significantly reduce disease progression and pancreatic necrosis in moderately severe and severe AP in a randomized, single-blind, phase 3 control trial involving 140 patients. 17 Here, we reported that the use of insulin, which is a widely used drug for controlling glucose and TG levels, was directly and independently associated with better prognosis in critically ill patients with AP.…”

Section: Discussionmentioning

confidence: 87%

Insulin Use Is Associated With Improved Outcomes in Critically Ill Patients With Acute Pancreatitis: A Retrospective Matched Cohort Study

Dai,

He,

et al. 2023

J Intensive Care Med

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Background Severe acute pancreatitis (SAP) has a mortality of 30% with no current targeted therapy. The potential protective effect of insulin on AP has been reported and needs to be confirmed. Thus, we aim to examine the effect of insulin treatment on the outcome of AP patients. Methods A retrospective study was performed using data from the Medical Information Mart for Intensive Care (MIMIC) database. Kruskal–Wallis test, t-tests, and Pearson's chi-squared test were used to compare differences between groups. Propensity score matching and further nearest neighbor matching were used to construct a matched cohort. Cox proportional hazards regression analyses, logistic regression analyses, and the doubly robust estimation method were used to assess the relationship between insulin use and mortality. Results Nine hundred patients were enrolled in the final analysis. Insulin was associated with better outcomes in AP patients admitted to ICU, and could act as an independent predictor for 30-day mortality (HR = 0.36, 95% CI = 0.24-0.55). Subgroup analysis showed that AP patients with heart failure or without kidney disease or respiratory failure may not benefit from insulin treatment. Conclusions Insulin treatment is independently associated with lower 30-day mortality in AP patients, except for those with heart failure or without kidney disease or respiratory failure.

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Section: Discussionmentioning

confidence: 87%

Insulin Use Is Associated With Improved Outcomes in Critically Ill Patients With Acute Pancreatitis: A Retrospective Matched Cohort Study

Dai,

He,

et al. 2023

J Intensive Care Med

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“…A recent randomized, single-bind, phase 3 control trial emphasized the potential benefits of LMWH in AP. The study found that LMWH can reduce necrosis of the pancreas, especially in the early phase of moderate and severe AP [76].…”

Section: Low-molecular-weight Heparin (Lmwh)mentioning

confidence: 82%

Recent Treatment Strategies for Acute Pancreatitis

Song,

Lee

2024

JCM

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Acute pancreatitis (AP) is a leading gastrointestinal disease that causes hospitalization. Initial management in the first 72 h after the diagnosis of AP is pivotal, which can influence the clinical outcomes of the disease. Initial management, including assessment of disease severity, fluid resuscitation, pain control, nutritional support, antibiotic use, and endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis, plays a fundamental role in AP treatment. Recent updates for fluid resuscitation, including treatment goals, the type, rate, volume, and duration, have triggered a paradigm shift from aggressive hydration with normal saline to goal-directed and non-aggressive hydration with lactated Ringer’s solution. Evidence of the clinical benefit of early enteral feeding is becoming definitive. The routine use of prophylactic antibiotics is generally limited, and the procalcitonin-based algorithm of antibiotic use has recently been investigated to distinguish between inflammation and infection in patients with AP. Although urgent ERCP (within 24 h) should be performed for patients with gallstone pancreatitis and cholangitis, urgent ERCP is not indicated in patients without cholangitis. The management approach for patients with local complications of AP, particularly those with infected necrotizing pancreatitis, is discussed in detail, including indications, timing, anatomical considerations, and selection of intervention methods. Furthermore, convalescent treatment, including cholecystectomy in gallstone pancreatitis, lipid-lowering medications in hypertriglyceridemia-induced AP, and alcohol intervention in alcoholic pancreatitis, is also important for improving the prognosis and preventing recurrence in patients with AP. This review focuses on recent updates on the initial and convalescent management strategies for AP.

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“…86 Several other clinical studies and drew close conclusions. 87,88 Thus, LMWH might be used as a simple, safe, economical, and effective method for the treatment of SAP with improved prognosis.…”

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confidence: 99%

Pathogenesis and Therapy of Coagulation Disorders in Severe Acute Pancreatitis

Gui¹,

Zhao²,

Huang³

et al. 2023

JIR

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Ischemia superimposed upon pancreatic edema leads to acute necrotizing pancreatitis. One possible mechanism contributing to ischemia is intravascular thrombogenesis since fibrin deposits have been detected in pancreatic capillaries by electron microscope. Current experimental and clinical data provided compelling evidence that the disorders in the blood coagulation system play a critical role in the pathogenesis of severe acute pancreatitis (SAP). This leads to microcirculatory failure of intra- and extrapancreatic organs and multiple organ failure and increases the case fatality rate. However, the mechanism of coagulopathy underlying SAP is not yet clear, although some anticoagulant drugs have entered clinical practice showing improvement in prognosis. Thus, enhanced understanding of the process might improve the treatment strategies with safety and high efficacy. Herein, the pathogenesis of the coagulation system of SAP was reviewed with a focus on the coagulation pathway, intercellular interactions, and complement system, thereby illustrating some anticoagulant therapies and potential therapeutic targets.

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Impact of low-molecular-weight heparin in the treatment of moderately severe and severe acute pancreatitis; a randomized, single blind, phase 3 control trial

Cited by 10 publications

References 5 publications

Insulin Use Is Associated With Improved Outcomes in Critically Ill Patients With Acute Pancreatitis: A Retrospective Matched Cohort Study

Insulin Use Is Associated With Improved Outcomes in Critically Ill Patients With Acute Pancreatitis: A Retrospective Matched Cohort Study

Recent Treatment Strategies for Acute Pancreatitis

Pathogenesis and Therapy of Coagulation Disorders in Severe Acute Pancreatitis

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