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Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study

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World journal of Gastroenterology 2023年第21期29卷 3328-3340页

作者： Noor j Sissingh jesse V Groen hester C Timmerhuis Marc G Besselink Bas Boekestijn Thomas L Bollen Bert A Bonsing Frederikus A Klok hjalmar C van Santvoort Robert C Verdonk casper h j van eijck jeanin E van hooft jan Sven D Mieog Department of Gastroenterology and hepatology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Research and Development St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Amsterdam UMCLocation University of AmsterdamAmsterdam 1081 HZNetherlands Amsterdam Gastroenterology Endocrinology Metabolism Amsterdam 1105 AZNetherlands Department of Radiology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Radiology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Medicine-Thrombosis and hemostasis Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery University Medical Centre UtrechtUtrechtUtrecht 3584 CXNetherlands Department of Gastroenterology and hepatology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Erasmus Medical CentreRotterdam 3015 GDNetherlands

BACKGROUND Splanchnic vein thrombosis(SVT)is a major complication of moderate and severe acute *** is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and *** To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute *** A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette *** threshold to assume group agreement was set at 75%.RESULTS The response rate was 67%(n=93).Seventy-one pancreatologists(77%)regularly prescribed therapeutic anticoagulation in case of SVT,and 12 pancreatologists(13%)for narrowing of splanchnic vein *** most common reason to treat SVT was to avoid complications(87%).Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation(90%).Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation(76%)and splenic vein thrombosis as the least preferred location(86%).The preferred initial agent was low molecular weight heparin(LMWh;87%).In the case vignettes,therapeutic anticoagulation was prescribed for acute portal vein thrombosis,with or without suspected infected necrosis(82%and 90%),and thrombus progression(88%).Agreement was lacking regarding the selection and duration of long-term anticoagulation,the indication for thrombophilia testing and upper endoscopy,and about whether risk of bleeding is a major barrier for therapeutic *** In this national survey,the pancreatologists seemed to agree on the use of therapeutic anticoagulation,using LMWh in the acute phase,for acute portal thrombosis and in the case of thrombus progression,irrespective of the presence of infected necrosis.

关键词： Acute pancreatitis Splanchnic vein thrombosis Therapeutic anticoagulation Bleeding Recanalization Outcomes

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