Abstract
This meta-analysis aimed to estimate the incidence of splanchnic vein thrombosis (SVT) in patients with acute pancreatitis and assess the effects of therapeutic anticoagulation. Systematic searches of the Medline, Embase, and Cochrane databases were undertaken to identify studies reporting the incidence and outcomes associated with SVT in patients with acute pancreatitis. The pooled incidence, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model. PROSPERO database registration no. CRD 42021230912. Only 18 of the 238 studies identified met the inclusion criteria. Of the 943 patients who had SVT, 264 (28.0%) received anticoagulation. The pooled incidence of SVT at first presentation of acute pancreatitis was 15% (95% CI 5 to 26%), but was 17% (95% CI 14 to 20%) in all studies. Recanalization was more likely to occur in the anticoagulation-treated than in the untreated group (OR 0.51, 95% CI 0.31 to 0.83, P=0.007). There were no differences in hemorrhagic complications (OR 2.27, 95% CI 0.81 to 6.37, P=0.12) or overall mortality (OR 2.37, 95% CI 0.86 to 6.52, P=0.10) in relation to the use of anticoagulation. The overall incidence of portal hypertension in patients was 60% (95% CI 55 to 65%). However, it was not possible to determine the incidence in each group. The incidence of SVT in patients with acute pancreatitis is significant. Treatment with anticoagulants improved the odds of recanalization but did not increase the risk of hemorrhagic complications or overall mortality.
Highlights
Vascular complications associated with acute pancreatitis are common and are a major cause of morbidity and mortality
The term splanchnic vein thrombosis (SVT) encompasses the three sites of portomesenteric thrombosis: splenic vein thrombosis (SpVT), portal vein thrombosis (PVT), and superior mesenteric vein thrombosis (SMVT), with SpVT being the commonest in patients with acute pancreatitis
Nine studies specified the protocol for anticoagulation (Table 1)3,21,22,24,25,28,30–32 and indications included triple vessel involvement,8 SVT in the absence of varices or collaterals,4,31
Summary
Vascular complications associated with acute pancreatitis are common and are a major cause of morbidity and mortality. The decision to treat SVT actively must be balanced with the risk of bleeding secondary to other vascular complications associated with acute pancreatitis, such as a bleed into a pseudocyst, erosion of branches of the coeliac axis and superior mesenteric artery, and development of pseudoaneurysms.. The decision to treat SVT actively must be balanced with the risk of bleeding secondary to other vascular complications associated with acute pancreatitis, such as a bleed into a pseudocyst, erosion of branches of the coeliac axis and superior mesenteric artery, and development of pseudoaneurysms.13,14 The aim of this systematic review and meta-analysis was to determine the incidence and outcomes of SVT in patients with acute pancreatitis managed with and without anticoagulation
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