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Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Necrotizing pancreatitis (NP) is a severe systemic inflammatory process. We have observed a high incidence of venous thromboembolism (VTE) in NP patients. However, remarkably few data exist to document the true incidence of VTE—including splanchnic vein thrombosis (SVT), extremity deep venous thrombosis (eDVT), and pulmonary embolism (PE)—in NP. Therefore, we sought to determine the incidence and risk factors for VTE in NP patients.

Methods

Retrospective review of all NP patients treated at a single academic center between 2005 and 2015. VTE diagnosis was confirmed by ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and/or ventilation/perfusion (V/Q) scan. Descriptive statistics and univariate analysis were applied where appropriate; p value < 0.05 was considered statistically significant.

Results

Five hundred and forty-five NP patients (median age 53 years; 65% males) were reviewed. VTE was diagnosed in 312 patients (57%). SVT was found in 50%, eDVT in 16%, and PE in 6%. VTE in multiple sites was found in 22% of patients. VTE was diagnosed a median of 37 days following pancreatitis diagnosis. Seventy-nine percent of patients required at least one surgical procedure over the course of their NP. Patients requiring surgery had a DVT incidence of 58%; however, VTE was diagnosed preoperatively in 63%. Male gender, history of previous DVT, infected necrosis, development of organ failure, and development of respiratory failure were identified as risk factors for VTE (p = 0.001–0.04) by univariate analysis.

Conclusions

Venous thromboembolism is extremely common in necrotizing pancreatitis. Regular ultrasound screening may be considered to facilitate early diagnosis in this extremely high-risk population.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA

    Alexandra M. Roch, Thomas K. Maatman, Rose A. Carr, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, C. Max Schmidt & Nicholas J. Zyromski

  2. Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, IN, USA

    Cameron L. Colgate

  3. General Surgery, Advanced Surgical Associates, Springfield, NJ, USA

    James Lopes

Authors
  1. Alexandra M. Roch
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  2. Thomas K. Maatman
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  3. Rose A. Carr
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  4. Cameron L. Colgate
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  5. Eugene P. Ceppa
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  6. Michael G. House
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  7. James Lopes
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  8. Attila Nakeeb
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  9. C. Max Schmidt
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  10. Nicholas J. Zyromski
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Contributions

Conception, design, data acquisition/analysis/interpretation: AMR, TKM, RAC, CLC, EPC, MGH, JL, AN, CMS, NJZ

Drafting/revision of work: AMR, TKM, RAC, CLC, EPC, MGH, JL, AN, CMS, NJZ

Final approval: AMR, TKM, RAC, CLC, EPC, MGH, JL, AN, CMS, NJZ

Accountability of work: AMR, TKM, RAC, CLC, EPC, MGH, JL, AN, CMS, NJZ

Corresponding author

Correspondence to Nicholas J. Zyromski.

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The authors declare that they have no conflict of interest.

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Alexandra M. Roch and Thomas K. Maatman contributed evenly to this manuscript and share co-first authorship.

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Roch, A.M., Maatman, T.K., Carr, R.A. et al. Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk. J Gastrointest Surg 23, 2430–2438 (2019). https://doi.org/10.1007/s11605-019-04124-0

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