Sissingh Noor J, Groen Jesse V, Koole Dylan, Klok Frederikus A, Boekestijn Bas, Bollen Thomas L, van Santvoort Hjalmar C, Verdonk Robert C, Bonsing Bert A, van Eijck Casper H J, van Hooft Jeanin E, Mieog J Sven D
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Pancreatology. 2022 Mar;22(2):235-243. doi: 10.1016/j.pan.2021.12.008. Epub 2021 Dec 22.
The optimal management of patients with acute pancreatitis (AP) and splanchnic vein thrombosis (SVT) remains unknown. This systematic review and meta-analysis aimed to see if therapeutic anticoagulation (AC) improves outcomes in patients with AP and SVT.
A systematic review was performed according to PRISMA guidelines. Main outcomes were recanalization, recurrent venous thromboembolism, development of varices, collaterals or cavernoma, haemorrhage and mortality. Meta-analysis were performed with the Mantel-Haenszel random effect models.
Seven retrospective cohort studies (3495 patients) were included. SVT occurred in 233 (7%) patients and involved most frequently the splenic vein (44%). Therapeutic AC was administered to 109 (47%) patients, most frequently to those with triple vessel thrombosis (72%) and least to those with isolated splenic vein (22%) or superior mesenteric vein thrombosis (0%). Most studies administered (low molecular weight) heparin followed by warfarin (duration ranged between 1.5 and 12 months). This meta-analysis showed an absolute risk difference of 9% (95% confidence interval [CI] = -11-28%) for recanalization, -3% (95% CI = -19-12%) for the development of varices, collaterals or cavernoma, 3% (95% CI = -6-12%) for haemorrhage and 2% (95% CI = -8-12%) for mortality.
Based on the currently available data, it remains unclear if therapeutic anticoagulation provides benefit to acute pancreatitis patients with splanchnic vein thrombosis. These results are based on low quality data underlining the need for further higher quality studies.
急性胰腺炎（AP）合并内脏静脉血栓形成（SVT）患者的最佳管理方案仍不明确。本系统评价和荟萃分析旨在探讨治疗性抗凝（AC）是否能改善AP合并SVT患者的预后。
根据PRISMA指南进行系统评价。主要结局包括再通、复发性静脉血栓栓塞、静脉曲张、侧支循环或海绵状血管瘤的形成、出血和死亡率。采用Mantel-Haenszel随机效应模型进行荟萃分析。
纳入7项回顾性队列研究（3495例患者）。233例（7%）患者发生SVT，最常累及脾静脉（44%）。109例（47%）患者接受了治疗性AC，其中接受治疗频率最高的是三支血管血栓形成的患者（72%），接受治疗频率最低的是孤立脾静脉血栓形成（22%）或肠系膜上静脉血栓形成（0%）的患者。大多数研究给予（低分子量）肝素，随后给予华法林（疗程为1.5至12个月）。该荟萃分析显示，再通的绝对风险差异为9%（95%置信区间[CI]=-11-28%），静脉曲张、侧支循环或海绵状血管瘤形成的绝对风险差异为-3%（95%CI=-19-12%），出血的绝对风险差异为3%（95%CI=-6-12%），死亡率的绝对风险差异为2%（95%CI=-8-12%）。
基于目前可得的数据，尚不清楚治疗性抗凝是否对急性胰腺炎合并内脏静脉血栓形成的患者有益。这些结果基于低质量数据，凸显了开展进一步高质量研究的必要性。
