Journal of clinical lipidology · 2026
Early administration of low molecular weight heparin in hypertriglyceridemia-induced acute pancreatitis: A propensity score-matched retrospective cohort study.
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Wan Jianhua, Kuang Maobin, Xiong Shixuan, Zou Yaoyu, He Wenhua, Zhu Yin, Lu Nonghua, Xia Liang
Аннотация
BACKGROUND: The incidence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is rising and is prone to a poor prognosis. Low molecular weight heparin (LMWH) has garnered attention in acute pancreatitis treatment due to its anti-inflammatory, microcirculation-improving effects, but evidence for its efficacy and safety specifically in HTG-AP is limited.
OBJECTIVE: To evaluate the impact of early LMWH administration (within 48 hours of admission) on in-hospital mortality and other clinical outcomes in patients with HTG-AP.
METHODS: Based on a single-center database (2005-2023), 2862 patients with HTG-AP were included (LMWH group: 960; non-LMWH group: 1902). LMWH treatment was administered within 48 hours of admission (mean duration: 7 days). The primary outcome was in-hospital mortality. Secondary outcomes included persistent organ failure and bleeding complications. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were used to adjust for baseline differences and evaluate LMWH efficacy.
RESULTS: After adjustment with PSM, IPTW, and OW, mortality was significantly lower in the LMWH group compared with the non-LMWH group (adjusted hazard ratio 0.44-0.47, all P < .05). LMWH significantly reduced the risk of persistent organ failure (P < .01) and the need for continuous renal replacement therapy (5.3% vs 8.3%, P = .01), without increasing bleeding risk (gastrointestinal bleeding: 0.3% vs 0.7%; abdominal bleeding: 1.0% vs 0.6%, all P > .05). Subgroup analysis showed more pronounced benefits in patients aged <60 years, those with diabetes, or those with Acute Physiology and Chronic Health Evaluation II ≥8.
CONCLUSION: Early application of LMWH was associated with a significant reduction in mortality and organ failure risk in patients with HTG-AP without increasing bleeding complications. Patients with severe disease, diabetes, or high inflammatory burden may derive greater benefit, but further mechanistic studies are needed to guide patient selection.
OBJECTIVE: To evaluate the impact of early LMWH administration (within 48 hours of admission) on in-hospital mortality and other clinical outcomes in patients with HTG-AP.
METHODS: Based on a single-center database (2005-2023), 2862 patients with HTG-AP were included (LMWH group: 960; non-LMWH group: 1902). LMWH treatment was administered within 48 hours of admission (mean duration: 7 days). The primary outcome was in-hospital mortality. Secondary outcomes included persistent organ failure and bleeding complications. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were used to adjust for baseline differences and evaluate LMWH efficacy.
RESULTS: After adjustment with PSM, IPTW, and OW, mortality was significantly lower in the LMWH group compared with the non-LMWH group (adjusted hazard ratio 0.44-0.47, all P < .05). LMWH significantly reduced the risk of persistent organ failure (P < .01) and the need for continuous renal replacement therapy (5.3% vs 8.3%, P = .01), without increasing bleeding risk (gastrointestinal bleeding: 0.3% vs 0.7%; abdominal bleeding: 1.0% vs 0.6%, all P > .05). Subgroup analysis showed more pronounced benefits in patients aged <60 years, those with diabetes, or those with Acute Physiology and Chronic Health Evaluation II ≥8.
CONCLUSION: Early application of LMWH was associated with a significant reduction in mortality and organ failure risk in patients with HTG-AP without increasing bleeding complications. Patients with severe disease, diabetes, or high inflammatory burden may derive greater benefit, but further mechanistic studies are needed to guide patient selection.