Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis

Abstract

Objectives Studies on the incidence of venous thromboembolism (VTE) in acute pancreatitis (AP) are scarce. We conducted a large database study to evaluate this relationship. Methods Data were extracted from a large electronic health record (Explorys; IBM Watson Health, Armonk, NY). We identified patients with AP in 2018 and 2019, analyzing VTE incidence at 30 days after diagnosis of AP. Univariate and multivariate analyses were performed to identify risk factors associated with VTE. Results A total of 25,620 cases of acute necrotizing pancreatitis (ANP) and 155,800 cases of acute nonnecrotizing pancreatitis (ANNP) were identified. The incidence of VTE was 7.1% for ANP, compared with 2.8% in ANNP (P < 0.001). On multivariate analysis, ANP conferred significantly greater odds of VTE (adjusted odds ratio, 2.78; 95% confidence interval, 2.73–2.84; P < 0.001), independent of other variables. In those with ANP, the presence of VTE was associated with a significantly higher mortality (23.5% vs 15.9%, P < 0.001). Conclusions Acute necrotizing pancreatitis carries near 2.5-fold risk of VTE, and a 3-fold risk of PE, compared with those with ANNP. Venous thromboembolism development in ANP is associated with higher mortality.

Long‐term risk of venous thromboembolism among patients with gastrointestinal non‐neoplastic and neoplastic diseases: A prospective cohort study of 484 211 individuals

“…Many studies have found an increased risk of VTE among patients with inflammatory bowel disease 8,17,25–28 . Likewise, two studies identified positive associations of acute and chronic pancreatitis with VTE, respectively 29,30 . Our analysis additionally found some moderate associations of gastroesophageal reflux disease, gastritis and duodenitis, irritable bowel syndrome, diverticulum, non‐alcoholic fatty liver disease, and biliary diseases with VTE risk.…”

“…8,17,[25][26][27][28] Likewise, two studies identified positive associations of acute and chronic pancreatitis with VTE, respectively. 29,30 Our analysis additionally found some moderate associations of gastroesophageal reflux disease, gastritis and duodenitis, irritable bowel syndrome, diverticulum, non-alcoholic fatty liver disease, and biliary diseases with VTE risk. The association for diverticular disease was found in other studies.…”

Necrotizing Pancreatitis: To Anticoagulate or Not to Anticoagulate?

“…In fact, thromboembolism is more prevalent in necrotizing pancreatitis. In a retrospective cross-sectional study, 7.1% of patients with acute necrotizing pancreatitis had a venous thromboembolic event, whereas only 2.8% of patients with acute non-necrotizing pancreatitis had a venous thromboembolic event [ 6 ]. Moreover, patients with thromboembolism had a higher mortality rate.…”

Contemporary Surgical Management of Pancreatic Necrosis

“…The development of NP has been associated with a 2 to 3 times higher rate of deep vein thrombosis and pulmonary embolism, respectively, than acute nonnecrotizing pancreatitis . Standard dosing of unfractionated and low-molecular-weight heparin has been shown to be insufficient in more than 75% of patients with NP, and subprophylactic anti–factor Xa levels in this context were significantly associated with the development of deep vein thrombosis on screening ultrasound examinations …”