急性胰腺炎患者肠系膜静脉血栓形成的治疗性抗凝：全国调查和病例分析研究。
Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study.
机构信息
Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands.
Department of Research and Development, St. Antonius Hospital, Nieuwegein 3420 EM, Netherlands.
出版信息
World J Gastroenterol. 2023 Jun 7;29(21):3328-3340. doi: 10.3748/wjg.v29.i21.3328.
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% ( = 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.
背景
内脏静脉血栓形成（SVT）是中重度急性胰腺炎的主要并发症。对于急性胰腺炎合并 SVT 的患者，是否应开始治疗性抗凝治疗尚无共识。
目的
深入了解急性胰腺炎中 SVT 的胰腺科医生的当前观点和临床决策。
方法
共向荷兰胰腺炎研究组和荷兰胰腺癌研究组的 139 名胰腺科医生提出了在线调查和病例案例调查。假设组内达成一致的阈值设定为 75%。
结果
回复率为 67%（=93）。71 名（77%）胰腺科医生经常在 SVT 情况下开具治疗性抗凝治疗，12 名（13%）医生在 SVT 导致内脏静脉腔狭窄时开具治疗性抗凝治疗。治疗 SVT 的最常见原因是避免并发症（87%）。急性血栓形成是开具治疗性抗凝治疗的最重要因素（90%）。门静脉血栓形成是启动治疗性抗凝治疗的首选部位（76%），脾静脉血栓形成是最不首选的部位（86%）。首选的初始药物是低分子肝素（LMWH；87%）。在病例案例中，对急性门静脉血栓形成，有或无疑似感染性坏死（82%和 90%）和血栓进展（88%）均开具了治疗性抗凝治疗。关于长期抗凝的选择和持续时间、血栓形成倾向测试和上消化道内镜检查的适应证以及出血风险是否是治疗性抗凝的主要障碍等问题，缺乏共识。
结论
在这项全国性调查中，胰腺科医生似乎同意使用治疗性抗凝治疗，在急性阶段使用 LMWH，用于急性门静脉血栓形成和血栓进展的情况，无论是否存在感染性坏死。
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