Skip to main content

Advertisement

SpringerLink
Log in

Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3-year single-centre experience

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Splanchnic vein thrombosis (SVT) is a possible complication of acute pancreatitis (AP). There are no precise guidelines on the use of anticoagulant therapy (AT) in these patients. The aim of the study was to determine the safety and the efficacy of AT in AP-associated SVT. Two hundred twenty-one patients were retrospectively and consecutively enrolled from the Pancreatic Outpatient Clinic of the “A. Gemelli” hospital. Patients had a diagnosis of AP and a diagnostic imaging to evaluate whether they had or not SVT. Twenty-seven out of 221 AP patients had SVT (12.21%) and AT therapy was administered to 16 patients (59.3%), for 5.2 ± 2.2 months. A therapeutic dose of low molecular weight heparin was administered (100 UI/kg b.i.d.) at the diagnosis, with fondaparinux 7.5 mg/day, or vitamin K antagonist, or the novel direct oral anti-coagulants, upon discharge. The presence of SVT resulted significantly associated to male sex (p = 0.002). The recanalization rates were 11/16 (68.7%) in patients who received AT, and 3/11 (27.3%) in patients who did not receive it. There was a significant difference between the recanalization rates with and without AT (p = 0.03, OR 5.87). No SVT recurrence was registered during follow-up. No treated patient developed haemorrhagic complications after AT. No deaths were recorded, either in the group undergoing AT or in the one that was not. In conclusion, AT in AP-associated SVT appears to be safe and effective; yet prospective clinical trials are needed to confirm our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Mallick IH, Winslet MC (2004) Vascular complications of pancreatitis. JOP J Pancreas 5(5):328–337

    Google Scholar 

  2. Mendelson RM, Anderson J, Marshall M, Ramsay D (2005) Vascular complications of pancreatitis. ANZ J Surg 75(12):1073–1079. https://doi.org/10.1111/j.1445-2197.2005.03607.x

    Article  PubMed  Google Scholar 

  3. Valla DC, Condat B (2000) Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 32(5):865–871

    Article  CAS  Google Scholar 

  4. Besselink MG (2011) Splanchnic vein thrombosis complicating severe acute pancreatitis. HPB 13(12):831–832. https://doi.org/10.1111/j.1477-2574.2011.00411.x

    Article  PubMed  PubMed Central  Google Scholar 

  5. Valla D (2015) Splanchnic vein thrombosis. Semin Thromb Hemost 41(5):494–502. https://doi.org/10.1055/s-0035-1550439

    Article  PubMed  Google Scholar 

  6. Ageno W, Dentali F, Squizzato A (2014) How I treat splanchnic vein thrombosis. Blood 124(25):3685–3691. https://doi.org/10.1182/blood-2014-07-551515

    Article  CAS  PubMed  Google Scholar 

  7. Nadkarni NA, Khanna S, Vege SS (2013) Splanchnic venous thrombosis and pancreatitis. Pancreas 42(6):924–931. https://doi.org/10.1097/MPA.0b013e318287cd3d

    Article  CAS  PubMed  Google Scholar 

  8. Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ (2011) Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB 13(12):839–845. https://doi.org/10.1111/j.1477-2574.2011.00375.x

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gonzelez HJ, Sahay SJ, Samadi B, Davidson BR, Rahman SH (2011) Splanchnic vein thrombosis in severe acute pancreatitis: a 2-year, single-institution experience. HPB 13(12):860–864. https://doi.org/10.1111/j.1477-2574.2011.00392.x

    Article  PubMed  PubMed Central  Google Scholar 

  10. Harris S, Nadkarni NA, Naina HV, Vege SS (2013) Splanchnic vein thrombosis in acute pancreatitis: a single-center experience. Pancreas 42(8):1251–1254. https://doi.org/10.1097/MPA.0b013e3182968ff5

    Article  PubMed  Google Scholar 

  11. Xu W, Qi X, Chen J, Su C, Guo X (2015) Prevalence of splanchnic vein thrombosis in pancreatitis: a systematic review and meta-analysis of observational studies. Gastroenterol Res Pract 2015:245460. https://doi.org/10.1155/2015/245460

    Article  PubMed  PubMed Central  Google Scholar 

  12. Easler J, Muddana V, Furlan A, Dasyam A, Vipperla K, Slivka A, Whitcomb DC, Papachristou GI, Yadav D (2014) Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Gastroenterol Hepatol 12(5):854–862. https://doi.org/10.1016/j.cgh.2013.09.068

    Article  PubMed  Google Scholar 

  13. Ahmed M, Aziz MU, Mansoor MA, Anwar S (2016) Vascular complications in cases of acute pancreatitis - CT scan based study. JPMA J Pak Med Assoc 66(8):977–989

    PubMed  Google Scholar 

  14. Ahmed SU, Rana SS, Ahluwalia J, Varma N, Sharma R, Gupta R, Kang M (2018) Role of thrombophilia in splanchnic venous thrombosis in acute pancreatitis. Ann Gastroenterol 31(3):371–378. https://doi.org/10.20524/aog.2018.0242

    Article  PubMed  PubMed Central  Google Scholar 

  15. Toque L, Hamy A, Hamel JF, Cesbron E, Hulo P, Robert S, Aube C, Lermite E, Venara A (2015) Predictive factors of splanchnic vein thrombosis in acute pancreatitis: a 6-year single-center experience. J Dig Dis 16(12):734–740. https://doi.org/10.1111/1751-2980.12298

    Article  CAS  PubMed  Google Scholar 

  16. Zhou J, Ke L, Yang D, Chen Y, Li G, Tong Z, Li W, Li J (2016) Predicting the clinical manifestations in necrotizing acute pancreatitis patients with splanchnic vein thrombosis. Pancreatology 16(6):973–978. https://doi.org/10.1016/j.pan.2016.10.001

    Article  PubMed  Google Scholar 

  17. Janczak DT, Mimier MK, McBane RD, Kamath PS, Simmons BS, Bott-Kitslaar DM, Lenz CJ, Vargas ER, Hodge DO, Wysokinski WE (2018) Rivaroxaban and apixaban for initial treatment of acute venous thromboembolism of atypical location. Mayo Clin Proc 93(1):40–47. https://doi.org/10.1016/j.mayocp.2017.10.007

    Article  CAS  PubMed  Google Scholar 

  18. Mimier MK, Janczak DT, McBane RD, Houghton DE, Wysokinski WE (2018) Thrombosis of atypical location: how to treat patients in the era of direct oral anticoagulants? Pol Arch Intern Med 128(10):604–608. https://doi.org/10.20452/pamw.4333

    Article  PubMed  Google Scholar 

  19. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, APC Working Group (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111. https://doi.org/10.1136/gutjnl-2012-302779

    Article  PubMed  Google Scholar 

  20. Heider TR, Azeem S, Galanko JA, Behrns KE (2004) The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg 239(6):876–880 (discussion 880–872)

  21. Mortele KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, Kalantari BN, Ros PR (2004) Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol 52(1):67–72. https://doi.org/10.1016/j.ejrad.2003.10.006

    Article  PubMed  Google Scholar 

  22. Dorffel T, Wruck T, Ruckert RI, Romaniuk P, Dorffel Q, Wermke W (2000) Vascular complications in acute pancreatitis assessed by color duplex ultrasonography. Pancreas 21(2):126–133

    Article  CAS  Google Scholar 

  23. Zhou J, Ke L, Tong Z, Li G, Li W, Li N, Li J (2015) Risk factors and outcome of splanchnic venous thrombosis in patients with necrotizing acute pancreatitis. Thromb Res 135(1):68–72. https://doi.org/10.1016/j.thromres.2014.10.021

    Article  CAS  PubMed  Google Scholar 

  24. De Stefano V, Martinelli I (2010) Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med 5(6):487–494. https://doi.org/10.1007/s11739-010-0413-6

    Article  PubMed  Google Scholar 

  25. Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010) Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol 16(2):143–155

    Article  Google Scholar 

  26. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, Denninger MH, Vidaud D, Condat B, Hadengue A, Primignani M, Garcia-Pagan JC, Janssen HL, Valla D, European Network for Vascular Disorders of the Liver (2010) Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 51(1):210–218. https://doi.org/10.1002/hep.23259

    Article  PubMed  Google Scholar 

  27. Kaleya RN, Boley SJ (1995) Acute mesenteric ischemia. Crit Care Clin 11(2):479–512

    Article  CAS  Google Scholar 

  28. Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE (2010) Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol 8(2):200–205. https://doi.org/10.1016/j.cgh.2009.09.019

    Article  PubMed  Google Scholar 

  29. Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D (2001) Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 120(2):490–497

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Danilo Pagliari, Francesco Antonio Mancarella, Massimiliano Musso, Marco Cintoni & Antonio Gasbarrini

  2. Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Rossella Cianci & Laura Franza

  3. Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Maria Gabriella Brizi

  4. Internal Medicine and Angiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Danilo Pagliari, Roberto Antonio Flore & Paolo Tondi

Authors
  1. Danilo Pagliari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rossella Cianci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Gabriella Brizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Antonio Mancarella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Massimiliano Musso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Cintoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Franza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roberto Antonio Flore
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Gasbarrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paolo Tondi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danilo Pagliari.

Ethics declarations

Conflict of interest

No potential conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

The procedures employed to draft this manuscript respect the ethical standards in the Helsinki Declaration of 1975, as revised in 2000, as well as the national law. This study was approved by the Ethical Committee of the Catholic University of the Sacred Heart.

Statement of human and animal rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committees.

Informed consent

A formal consent was obtained from all the recruited patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pagliari, D., Cianci, R., Brizi, M.G. et al. Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3-year single-centre experience. Intern Emerg Med 15, 1021–1029 (2020). https://doi.org/10.1007/s11739-019-02271-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-019-02271-5

Keywords

Search

Navigation