A Global Survey of Splanchnic Venous Thrombosis Directed Treatment in Association with Acute Pancreatitis (LORDS-PANC)

Abstract

Introduction: Splanchnic venous thrombosis (SpVT) is a rare but important complication of severe acute pancreatitis (AP). A literature review has demonstrated a lack of high-quality studies and evidence-based guidelines for the treatment of SpVT in AP. The aim of this study was to determine the current approaches to the management of SpVT in patient with AP. Methods: The on-line survey was constructed by a group of international experts in the management of acute pancreatitis. The 23 questions covered respondent's demography, seniority, and experience with the management of SpVT with a specific focus on approaches to therapeutic anticoagulation. Results: There were 224 respondents from 25 HPB units globally (Fig. 1). 92% of responders were from tertiary hospitals and predominantly consultants (86%) who regularly manage patients with AP. There were 85% of respondents who routinely prescribe prophylactic anticoagulation in patients with AP. Only 36% ‘routinely’ prescribe therapeutic anticoagulation for SpVT, while 25% ‘often’ prescribe and 32% ‘never’ prescribe therapeutic anticoagulation. There were 83% respondents to the questions regarding the need for higher-level evidence. 92% of responders considered a clinical trial was justified and 88% were willing to contribute patients to the trial. Their reasons for not being willing to contribute were concern about bleeding risk and/or logistic concerns. Conclusion: There is global variation in the use of therapeutic anticoagulation for SpVT associated with AP. The majority of respondents agree on the need for high-quality evidence and were prepared to participate in a clinical trial.