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

作　　者：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 

机构地区：[1]Department of Gastroenterology and Hepatology,Leiden University Medical Centre,Leiden 2333 ZA,Netherlands [2]Department of Research and Development,St.Antonius Hospital,Nieuwegein 3420 EM,Netherlands [3]Department of Surgery,Leiden University Medical Centre,Leiden 2333 ZA,Netherlands [4]Department of Surgery,St.Antonius Hospital,Nieuwegein 3420 EM,Netherlands [5]Department of Surgery,Amsterdam UMC,Location University of Amsterdam,Amsterdam 1081 HZ,Netherlands [6]Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam 1105 AZ,Netherlands [7]Department of Radiology,Leiden University Medical Centre,Leiden 2333 ZA,Netherlands [8]Department of Radiology,St.Antonius Hospital,Nieuwegein 3420 EM,Netherlands [9]Department of Medicine-Thrombosis and Hemostasis,Leiden University Medical Centre,Leiden 2333 ZA,Netherlands [10]Department of Surgery,University Medical Centre Utrecht,Utrecht,Utrecht 3584 CX,Netherlands [11]Department of Gastroenterology and Hepatology,St.Antonius Hospital,Nieuwegein 3420 EM,Netherlands [12]Department of Surgery,Erasmus Medical Centre,Rotterdam 3015 GD,Netherlands

出　　处：《World Journal of Gastroenterology》2023年第21期3328-3340,共13页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND 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.AIM To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis.METHODS 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%.RESULTS 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.CONCLUSION 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.

关 键 词：Acute pancreatitis Splanchnic vein thrombosis Therapeutic anticoagulation BLEEDING RECANALIZATION OUTCOMES 

分 类 号：R576[医药卫生—消化系统]