A selective anticoagulation policy for splanchnic vein thrombosis in acute pancreatitis is associated with increased recanalisation rates and fewer bleeding complications

ABSTRACT NUMBER: NESTAC MEDAL FOR MEDICAL STUDENTS_5

MAIN ABSTRACT TEXT

Introduction
There is a paucity of data on the incidence, risk factors, and treatment of splanchnic vein thrombosis (SVT) in acute pancreatitis (AP).

Methods
All AP admissions between 2018 – 2021 across North East of England were included. Anticoagulation was considered in the presence of superior mesenteric vein/portal vein (SMV/PV) thrombus or progressive splenic vein thrombus (SpVT). The impact of such a selective anticoagulation policy, on vein recanalisation rates and bleeding complications were explored.

Results
401 patients (median age 58) were admitted with AP. 109 patients (27.2%) developed SVT. The splenic vein in isolation was the most common site (n=46) followed by SMV/PV (n= 36) and combined SMV/PV and SpVT (n=27). On multivariate logistic regression alcohol aetiology (OR 2.64, 95% CI [1.43-5.01]) and >50% necrosis of the pancreas (OR 14.6, 95% CI [1.43-383.9]) increased the risk of developing SVT. The rate of recanalization with anticoagulation was higher for PVT (66.7%; 42/63) than in SpVT ( 2/11; p=0.003). 5/74 of anticoagulated patients developed bleeding complications while 0/35 patients not anticoagulated had bleeding complications (p=0.4).

Conclusion
The risk of SVT increases with AP severity and with pancreatic necrosis. A selective anticoagulation policy for PVT and progressive SpVT was associated with increased recanalisation rates and fewer bleeding complications.