Introduction: Acute pancreatitis (AP) is an inflammatory process with a wide variety of clinical manifestations and sequelae. Splanchnic vein thrombosis (SVT), defined as thrombosis of the portal vein, mesenteric veins, or splenic vein, can be seen in a range of intra-abdominal inflammatory processes including AP, as well as in malignancies, inherited hypercoagulable states, and most commonly cirrhosis. There is a paucity of data regarding outcomes of SVT due to AP. The aim of this study is to review clinical outcomes of patients with mesenteric or splenic vein thrombosis due to AP who received therapeutic anticoagulation compared to those who did not receive anticoagulation.
Methods: We performed a retrospective chart review of patients who were diagnosed with splenic or mesenteric vein thrombosis in the setting of AP at our center from 2008-2021. A total of 395 patients were identified. 255 patients with portal vein thrombosis were excluded. A further 19 patients with other indications for anticoagulation (e.g., atrial fibrillation, mechanical valve, DVT/PE) were excluded. Age, sex, location of thrombosis, and initiation of anticoagulation were recorded. Categorical variables of anticoagulation and no anticoagulation were compared with incidence of death, blood transfusion, EGD and colonoscopy in one year using the Chi-Square test.
Results: A total of 121 patients identified as having splenic or mesenteric vein thrombosis in setting of AP without any other indication for anticoagulation. 68 were placed on anticoagulation while 53 were not. There was statistically significant association for incidence of EGD and colonoscopy in one year in the anticoagulation group compared to the group on no anticoagulation. While the anticoagulation group was associated with increased rate of need for transfusion (35% vs 26%) and death (10% vs 4%) compared to the group on no anticoagulation, these findings were not statistically significant.
Discussion: Use of anticoagulation solely for splenic or mesenteric vein thrombosis in setting of AP was associated with increased use of endoscopy in one year compared to those not started on anticoagulation. While increased mortality at one year and need for blood transfusion was seen in those started on anticoagulation, this was not statically significant. Further investigation including larger sample size and prospective data collection to evaluate is needed.
