Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A systematic review and meta-analysis

Sissingh, Noor J.; Groen, Jesse V.; Koole, D.; Klok, Frederikus A.; Boekestijn, Bas; Bollen, Thomas L.; Santvoort, Hjalmar C. van; Verdonk, Robert C.; Bonsing, Bert A.; Eijck, Casper H.J. van; Hooft, Jeanin E. van; Mieog, J. Sven D.

doi:10.1016/j.pan.2021.12.008

Cited by 23 publications

(23 citation statements)

References 41 publications

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“…However, this issue has not been explored yet in previous meta-analyses. [14][15][16][17] Fifth, only a random-effects model was employed. Accordingly, our statistical results should be more conservative.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation Therapy for Splanchnic Vein Thrombosis Associated With Acute Pancreatitis: A Systematic Review and Meta-Analysis

Wang

Gao

et al. 2023

Clin Appl Thromb Hemost

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Splanchnic vein thrombosis (SVT) is not rare in patients with acute pancreatitis. It remains unclear about whether anticoagulation should be given for acute pancreatitis-associated SVT. The PubMed, EMBASE, and Cochrane Library databases were searched. Rates of SVT recanalization, any bleeding, death, intestinal ischemia, portal cavernoma, and gastroesophageal varices were pooled and compared between patients with acute pancreatitis-associated SVT who received and did not receive therapeutic anticoagulation. Pooled rates and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity among studies was evaluated. Overall, 16 studies including 698 patients with acute pancreatitis-associated SVT were eligible. After therapeutic anticoagulation, the pooled rates of SVT recanalization, any bleeding, death, intestinal ischemia, portal cavernoma, and gastroesophageal varices were 44.3% (95%CI = 32.3%-56.6%), 10.7% (95%CI = 4.9%-18.5%), 13.3% (95%CI = 6.9%-21.4%), 16.8% (95%CI = 6.9%-29.9%), 21.2% (95%CI = 7.5%-39.5%), and 29.1% (95%CI = 16.1%-44.1%), respectively. Anticoagulation therapy significantly increased the rate of SVT recanalization (RR = 1.69; 95%CI = 1.29-2.19; P < .01), and marginally increased the risk of bleeding (RR = 1.98; 95%CI = 0.93-4.22; P = .07). The rates of death (RR = 1.42; 95%CI = 0.62-3.25; P = .40), intestinal ischemia (RR = 2.55; 95%CI = 0.23-28.16; P = .45), portal cavernoma (RR = 0.51; 95%CI = 0.21-1.22; P = .13), and gastroesophageal varices (RR = 0.71; 95%CI = 0.38-1.32; P = .28) were not significantly different between patients who received and did not receive anticoagulation therapy. Heterogeneity was statistically significant in the meta-analysis of intestinal ischemia, but not in those of SVT recanalization, any bleeding, death, portal cavernoma, or gastroesophageal varices. Anticoagulation may be effective for recanalization of acute pancreatitis-associated SVT, but cannot improve the survival. Randomized controlled trials are warranted to further investigate the clinical significance of anticoagulation therapy in such patients.

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Section: Discussionmentioning

confidence: 99%

Anticoagulation Therapy for Splanchnic Vein Thrombosis Associated With Acute Pancreatitis: A Systematic Review and Meta-Analysis

Wang

Gao

et al. 2023

Clin Appl Thromb Hemost

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“…However, no clear literature or guidelines exist. A meta-analysis by Sissingh et al 13 compared therapeutic anticoagulation against no intervention in those with SVT secondary to acute pancreatitis and was ultimately unable to prove a benefit in mortality, rates of recanalization, or formation of varices in either group. Further randomized clinical trials are needed to illustrate the benefit of anticoagulation in these cases.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Bleeding Secondary to Splenic Artery Pseudoaneurysm: A Delayed Complication of a Lumen-Apposing Metal Stent

et al. 2023

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Lumen-apposing metal stents (LAMSs) have been widely used for drainage of peripancreatic collections. A 71-year-old woman with a history of necrotizing pancreatitis who underwent LAMS placement 3 months ago for symptomatic pancreatic fluid collection presented with hematochezia and hemodynamic instability. Computed tomographic angiography of the abdomen showed concerns for stent erosion into the splenic artery. Esophagogastroduodenoscopy revealed a large pulsating nonbleeding vessel within the LAMS. She underwent a mesenteric angiogram, which showed splenic artery pseudoaneurysm, and coil embolization was performed. Gastrointestinal bleeding secondary to pseudoaneurysm should be considered in patients with recent LAMS placement who present with signs of gastrointestinal bleeding.

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“…Sissingh et al 4 , conducted a systematic review and meta-analysis of seven retrospective cohort studies. The primary outcomes of their study were similar to those reported on by Chandan et al , and described rates of recanalization, haemorrhage, and mortality in addition to recurrent venous thromboembolism, development of varices, collaterals or cavernomas.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, their study differed from those reviewed within this article and focused on patients with underlying liver cirrhosis, myeloproliferative neoplasms, and solid organ malignancies with or without thrombophilia. Norton et al 1 highlighted the overall lack of randomized studies addressing this question whilst the meta-analysis conducted by Sissingh et al 4 , concluded that the lack of data was insufficient to conclude if therapeutic AC was beneficial.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic anticoagulation in patients with acute pancreatitis and splanchnic vein thrombosis: a best evidence topic

Redman,

Panahi,

Bananis

et al. 2023

Annals of Medicine &Amp; Surgery

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A Best Evidence Topic in general surgery was written according to a structured protocol. The clinical question addressed was: In adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be advisable considering the rates of vessel recanalization and bleeding complications? 424 papers were found on Ovid Embase and Medline whilst 222 were found on PubMed using the reported literature search. From these, 5 articles represented the best evidence to the clinical question. The authors, publication dates, countries, patient groups, study outcomes and results of these papers were tabulated. There were three systematic reviews with meta-analyses, one systematic review without meta-analysis and one randomized, retrospective study. We conclude that among patients with splanchnic vein thrombosis in the context of acute pancreatitis, therapeutic anti-coagulation improved the rates of recanalization without increasing the risk of bleeding complications. However, there remains a need for randomized studies to address this clinical dilemma to further increase the quality of available evidence.

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Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A systematic review and meta-analysis

Cited by 23 publications

References 41 publications

Anticoagulation Therapy for Splanchnic Vein Thrombosis Associated With Acute Pancreatitis: A Systematic Review and Meta-Analysis

Anticoagulation Therapy for Splanchnic Vein Thrombosis Associated With Acute Pancreatitis: A Systematic Review and Meta-Analysis

Gastrointestinal Bleeding Secondary to Splenic Artery Pseudoaneurysm: A Delayed Complication of a Lumen-Apposing Metal Stent

Therapeutic anticoagulation in patients with acute pancreatitis and splanchnic vein thrombosis: a best evidence topic

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