Published online Jun 7, 2023. doi: 10.3748/wjg.v29.i21.3328
Peer-review started: March 3, 2023
First decision: March 24, 2023
Revised: April 3, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: June 7, 2023
Splanchnic vein thrombosis (SVT) is a major complication of moderate and severe acute pancreatitis. There is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and SVT.
To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis.
A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette survey. The threshold to assume group agreement was set at 75%.
The response rate was 67% (n = 93). Seventy-one pancreatologists (77%) regularly prescribed therapeutic anticoagulation in case of SVT, and 12 pancreatologists (13%) for narrowing of splanchnic vein lumen. The most common reason to treat SVT was to avoid complications (87%). Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation (90%). Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation (76%) and splenic vein thrombosis as the least preferred location (86%). The preferred initial agent was low molecular weight heparin (LMWH; 87%). In the case vignettes, therapeutic anticoagulation was prescribed for acute portal vein thrombosis, with or without suspected infected necrosis (82% and 90%), and thrombus progression (88%). Agreement was lacking regarding the selection and duration of long-term anticoagulation, the indication for thrombophilia testing and upper endoscopy, and about whether risk of bleeding is a major barrier for therapeutic anticoagulation.
In this national survey, the pancreatologists seemed to agree on the use of therapeutic anticoagulation, using LMWH in the acute phase, for acute portal thrombosis and in the case of thrombus progression, irrespective of the presence of infected necrosis.
Core Tip: Splanchnic vein thrombosis is a relatively common complication of moderate and severe acute pancreatitis, but there is still much debate about its treatment with therapeutic anticoagulation. This national survey and case vignette study among 93 pancreatologists demonstrates that the majority prescribe therapeutic anticoagulation for acute portal vein thrombosis and thrombus progression in patients with or without infected necrosis, despite the absence of evidence supporting its use. Whether this collective opinion is accurate needs to be confirmed in future (preferably prospective) studies.