Splanchnic vein thrombosis in patients with pancreatitis: Outcome and impact of anticoagulation

Abstract

Introduction: Splanchnic venous thrombosis (SVT) is a frequent complication of acute pancreatitis (AP) and may worsen the prognosis. There are no definite recommendations for the management of SVT. Our objectives were to analyze the recanalization rate and short and long-term complications of SVT.

Patients and methods: Single-center retrospective cohort study, which included patients hospitalized for AP complicated by SVT within the first 30 days. The primary endpoint was venous recanalization. Secondary endpoints were portal hypertension, gastrointestinal bleeding, complications of anticoagulation, and mortality.

Results: Between 2014 and 2018, 711 patients were hospitalized with AP; 121 (17 %) developed SVT and 88 were included in the analysis. Venous thrombosis involved the portal vein (27 %), splenic vein (21 %), superior mesenteric vein (16 %), 2 sites (19 %) or 3 sites (14 %). Of them, 78 % of patients received anticoagulation. After a median follow-up of 30 months, thrombosed vessel(s) got recanalized in 42 % of patients within a median of 7 months. Thrombosis extension was observed in 18 % of patients. The only factor associated with non-recanalization was portal vein or multi-site involvement (p = 0.004). Anticoagulation treatment was not associated with a higher rate of recanalization. Portal hypertension developed in 56 % of patients and varices rupture occurred in 9 % of patients. The only predictive factor of portal hypertension was non-recanalization of the thrombosed vessel (p < 0,001).

Conclusion: Recanalization was observed in 42 % of patients with SVT complicating in AP. Non-recanalization was the only risk for portal hypertension. Our study suggests an absence of benefit of anticoagulation.

Keywords: Acute pancreatitis; Anticoagulation; Mesenteric thrombosis; Portal hypertension; Portal thrombosis; Splenic thrombosis.