Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2023; 29(21): 3328-3340
Published online Jun 7, 2023. doi: 10.3748/wjg.v29.i21.3328
Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study
Noor J Sissingh, Jesse V Groen, Hester C Timmerhuis, Marc G Besselink, Bas Boekestijn, Thomas L Bollen, Bert A Bonsing, Frederikus A Klok, Hjalmar C van Santvoort, Robert C Verdonk, Casper H J van Eijck, Jeanin E van Hooft, Jan Sven D Mieog
Noor J Sissingh, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands
Noor J Sissingh, Hester C Timmerhuis, Department of Research and Development, St. Antonius Hospital, Nieuwegein 3420 EM, Netherlands
Jesse V Groen, Bert A Bonsing, Jan Sven D Mieog, Department of Surgery, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands
Hester C Timmerhuis, Hjalmar C van Santvoort, Department of Surgery, St. Antonius Hospital, Nieuwegein 3420 EM, Netherlands
Marc G Besselink, Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam 1081 HZ, Netherlands
Marc G Besselink, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam 1105 AZ, Netherlands
Bas Boekestijn, Department of Radiology, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands
Thomas L Bollen, Department of Radiology, St. Antonius Hospital, Nieuwegein 3420 EM, Netherlands
Frederikus A Klok, Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands
Hjalmar C van Santvoort, Department of Surgery, University Medical Centre Utrecht, Utrecht, Utrecht 3584 CX, Netherlands
Robert C Verdonk, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein 3420 EM, Netherlands
Casper H J van Eijck, Department of Surgery, Erasmus Medical Centre, Rotterdam 3015 GD, Netherlands
Author contributions: Sissingh NJ, Groen JV, and Mieog JSD designed the study; all authors critically assessed the study design; Boekestijn B and Bollen TL provided the radiological images; Sissingh NJ, van Hooft JE, Mieog JSD, and van Eijck CHJ sent or promoted the study; Sissingh NJ did the statistical analysis and wrote the initial draft of the manuscript; Groen JV, Timmerhuis HC, Besselink MG, Boekestijn B, Bollen TL, Bonsing BA, Klok FA, van Santvoort HC, Verdonk RC, van Eijck CHJ, van Hooft JE, and Mieog JSD critically assessed and edited the manuscript; Sissingh NJ coordinated the writing process and revised the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: This survey research is not subject to the Dutch Medical Research involving Human Subjects Acts (WMO) as participants are not subject to procedures or are required to follow rules of behavior. Consequently, this study does not need a full review by an accredited MREC or the CCMO.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: Requests for data can be made to the corresponding author and will be discussed during a meeting of the Dutch Pancreatitis Study Group. After approval by the Dutch Pancreatitis Study Group, data that underlie the results reported in this study, will be shared.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jan Sven D Mieog, MD, PhD, Department of Surgery, Leiden University Medical Centre, 2 Albinusdreef, Leiden 2333 ZA, Netherlands. j.s.d.mieog@lumc.nl
Received: March 3, 2023
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.

Keywords: Acute pancreatitis, Splanchnic vein thrombosis, Therapeutic anticoagulation, Bleeding, Recanalization, Outcomes

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.