Does the risk outweigh the benefit? Clot progression, recanalization & complications of anticoagulation therapy in acute pancreatitis with concomitant splanchnic vein thrombosis.

INTRODUCTION

The purpose was to evaluate the association between AC use and vessel recanalization, thrombus progression, and bleeding complications in patients with pancreatitis-induced splanchnic vein thrombosis(SVT).

METHODS

Retrospective review of patients with necrotizing pancreatitis between 2015 and 2021. Demographics, pancreatitis extent and etiology, thrombus location (splenic vein(SV) vs portomesenteric vein(PMV)), AC use, and bleeding complications were collected. All imaging within one year of SVT diagnosis were reviewed. Predictors of recanalization, progression and bleeding were identified.

RESULTS

Of 529 pancreatitis patients, 73(13.8%) developed SVT(47.9% SV, 52.1% PMV). PMV thrombosis was associated with higher AC use(50%vs.17.1%,p = 0.01) and bleeding interventions(24.3%vs.5.9%,p = 0.005). SV thrombosis had low rates of progression and bleeding regardless of AC, though AC increased recanalization. In PMV thrombosis, progression and bleeding were driven by disease severity (pseudocyst, BISAP, necrosis), with AC playing a secondary role.

CONCLUSION

Outcomes in pancreatitis-induced SVT are driven by disease severity rather than AC alone, supporting a selective, risk-stratified treatment approach.