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

Abstract

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.