Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study

Table 1 Details of respondents, n (%)

Demographics	n = 93
Specialty
Surgeon	25 (27)
Gastroenterologist	67 (72)
Intensivist	1 (1)
Type of hospital
Academic	28 (30)
Non-academic, teaching hospital	60 (65)
Non-academic, non-teaching hospital	5 (5)
Experience in treating patients with acute pancreatitis
0-5 years	10 (11)
5-10 years	27 (29)
10-15 years	17 (18)
15-20 years	23 (25)
> 20 years	16 (17)

Table 2 Survey results: Indication for and details of treatment with therapeutic anticoagulation, n (%)

Item	Total (n = 93)
Do you prescribe therapeutic AC in case of detected thrombosis in one (or more) of the splanchnic veins?
Always	23 (25)
Usually	48 (52)
Sometimes	21 (23)
Never	1 (1)
Do you prescribe therapeutic AC in case of detected luminal narrowing of one (or more) of the splanchnic veins?
Always	3 (3)
Usually	9 (10)
Sometimes	29 (31)
Never	52 (56)
Main reason(s) to start therapeutic AC (multiple answers were possible)
To achieve vessel recanalization	52 (56)
To avoid complications	81 (87)
To prevent formation of altered venous anatomy	31 (33)
To prevent recurrence of SVT	27 (29)
To prevent another venous thromboembolism	30 (32)
Other reason1	1 (1)
Do you screen for an underlying prothrombotic disorder?
Always	2 (2)
Usually	12 (13)
Sometimes	25 (27)
Only in patients with a history of one (or more) thrombotic events	40 (43)
Never	14 (15)
Which initial type of therapeutic AC do you prefer?
(Low molecular weight) heparin subcutaneous	81 (87)
Unfractionated heparin intravenous	4 (4)
Direct oral anticoagulation	3 (3)
Vitamin K antagonist	4 (4)
Platelet aggregation inhibitor	1 (1)
Urokinase/recombinant tissue plasminogen activator	0
Which follow-up type of therapeutic AC do you prefer?
(Low molecular weight) heparin subcutaneous	9 (10)
Unfractionated heparin intravenous	0
Direct oral anticoagulation	53 (57)
Vitamin K antagonist	29 (31)
Platelet aggregation inhibitor	2 (2)
Urokinase/recombinant tissue plasminogen activator	0
Do you generally follow-up SVT after index admission?
Yes, clinically only	5 (5)
Yes, with imaging	79 (85)
No	9 (10)
After how long do you usually stop the therapeutic AC?
In case of achieved radiological recanalization	13 (14)
3 mo	35 (38)
6 mo	42 (45)
12 mo	3 (3)
Never	0

¹In free text: expansion of thrombosis.

AC: Anticoagulation; SVT: Splanchnic vein thrombosis.

Table 3 Survey results: Determinants of prescribing therapeutic anticoagulation, n (%)

Item	Total (n = 93)
Do you consider of ... the thrombosis as an important factor to prescribe therapeutic AC? (multiple answers were possible)
Age (acute or chronic)	78 (84)
Anatomical location (portal, splenic or superior mesenteric vein)	42 (45)
Degree (total or partial)	45 (48)
Extent (isolated thrombosis or thrombosis in several segments)	49 (53)
Progression (over time)	40 (43)
When do you prescribe therapeutic AC? In case of:
(Sub)acute thrombosis	84 (90)
Chronic thrombosis	0
Both	9 (10)
Rank the anatomical location of the thrombosis from most likely to less likely to start therapeutic AC:
Portal vein-splenic vein-superior mesenteric vein	9 (10)
Portal vein-superior mesenteric vein-splenic vein	61 (66)
Splenic vein-portal vein-superior mesenteric vein	0
Splenic vein-superior mesenteric vein-portal vein	1 (1)
Superior mesenteric vein-portal vein-splenic vein	19 (20)
Superior mesenteric vein-splenic vein-portal vein	3 (3)
When do you prescribe therapeutic AC? In case of:
Total thrombosis	9 (10)
Partial thrombosis	5 (5)
Both	79 (85)
Do you consider the risk of ... as a major barrier to prescribe therapeutic AC? (multiple answers were possible)
Bleeding in general	52 (56)
Bleeding related to portal hypertension	17 (18)
Bleeding related to pseudoaneurysm	49 (53)
Other risk1	1 (1)
Does the need for invasive interventions for local complications of acute pancreatitis influence your decision regarding AC therapy?
Yes	48 (52)
No	45 (48)

¹In free text: CVA bleeding history.

AC: Anticoagulation; SVT: Splanchnic vein thrombosis.