Anticoagulation in Acute Pancreatitis Related Thrombosis: Practice Variations

Document Type

Article

Abstract

Introduction: Pancreatitis-induced thrombosis is a notable complication of pancreatic inflammation, where the inflammation can extend to the splenic, portal, or superior mesenteric veins (SMV) leading to thrombus formation. The acute inflammation resolves with appropriate treatment of the underlying pancreatic condition, suggesting that complications associated with vein inflammation can also be mitigated without initiation of anticoagulation. This study aims to investigate whether patients admitted with acute pancreatitis and diagnosed with a thrombus are initiated on anticoagulation therapy and the complications associated with that

Methods: This is a retrospective chart review on 43 patients admitted to the hospital for acute pancreatitis and were found to have a thrombus in the splenic vein, portal vein, or SMV. Variables such as type of pancreatitis, severity of pancreatitis, initiation of what anticoagulation, duration of therapy, portal hypertension complications, bleeding complications, and mortality were all obtained

Results: Out of 43 patients admitted for acute pancreatitis with thrombus, 7 were not placed on anticoagulation therapy; 4 of these had splenic thrombus and 3 had portal thrombus. Of the 36 patients who received anticoagulation, 21 were started on Eliquis, 3 on Warfarin, 3 on Lovenox, and 3 on Xarelto. The duration of anticoagulation therapy ranged from 30 days to indefinite. 12 patients were placed on indefinite anticoagulation, although only 3 had a history necessitating prolonged anticoagulation. 7 patients were placed on anticoagulation for 90 days, and 6 for 180 days. Additionally, 7 patients exhibited evidence of portal hypertension, and 4 experienced bleeding complications while on anticoagulation therapy

Conclusion: While the literature indicates that patients with thrombosis related to acute pancreatitis do not need anticoagulation, clinical practice varies widely. of our 43 patients, 82% were placed on anticoagulation. Although some studies recommend a 3-month duration for anticoagulation therapy, only 19% of our patients adhered to this guideline. Many patients were either lost to follow-up and continued taking anticoagulation indefinitely, or their outpatient providers maintained them on anticoagulation indefinitely. Anticoagulation carries significant risks and this study highlights the lack of established guidelines for managing pancreatitis-induced thrombosis and underscores the need for standardized protocols to optimize patient outcomes and minimize risks.

First Page

S54

Last Page

S55

Publication Date

10-1-2024

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