Meta-Analysis Interest Group & Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China.
Postgraduate College, China Medical University, Shenyang, China.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231188718. doi: 10.1177/10760296231188718.
Splanchnic vein thrombosis (SVT) is not rare in patients with acute pancreatitis. It remains unclear about whether anticoagulation should be given for acute pancreatitis-associated SVT. The PubMed, EMBASE, and Cochrane Library databases were searched. Rates of SVT recanalization, any bleeding, death, intestinal ischemia, portal cavernoma, and gastroesophageal varices were pooled and compared between patients with acute pancreatitis-associated SVT who received and did not receive therapeutic anticoagulation. Pooled rates and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity among studies was evaluated. Overall, 16 studies including 698 patients with acute pancreatitis-associated SVT were eligible. After therapeutic anticoagulation, the pooled rates of SVT recanalization, any bleeding, death, intestinal ischemia, portal cavernoma, and gastroesophageal varices were 44.3% (95%CI = 32.3%-56.6%), 10.7% (95%CI = 4.9%-18.5%), 13.3% (95%CI = 6.9%-21.4%), 16.8% (95%CI = 6.9%-29.9%), 21.2% (95%CI = 7.5%-39.5%), and 29.1% (95%CI = 16.1%-44.1%), respectively. Anticoagulation therapy significantly increased the rate of SVT recanalization (RR = 1.69; 95%CI = 1.29-2.19; < .01), and marginally increased the risk of bleeding (RR = 1.98; 95%CI = 0.93-4.22; = .07). The rates of death (RR = 1.42; 95%CI = 0.62-3.25; = .40), intestinal ischemia (RR = 2.55; 95%CI = 0.23-28.16; = .45), portal cavernoma (RR = 0.51; 95%CI = 0.21-1.22; = .13), and gastroesophageal varices (RR = 0.71; 95%CI = 0.38-1.32; = .28) were not significantly different between patients who received and did not receive anticoagulation therapy. Heterogeneity was statistically significant in the meta-analysis of intestinal ischemia, but not in those of SVT recanalization, any bleeding, death, portal cavernoma, or gastroesophageal varices. Anticoagulation may be effective for recanalization of acute pancreatitis-associated SVT, but cannot improve the survival. Randomized controlled trials are warranted to further investigate the clinical significance of anticoagulation therapy in such patients.
内脏静脉血栓形成（SVT）在急性胰腺炎患者中并不罕见。目前尚不清楚急性胰腺炎相关 SVT 是否应进行抗凝治疗。检索了 PubMed、EMBASE 和 Cochrane Library 数据库。对接受和未接受治疗性抗凝治疗的急性胰腺炎相关 SVT 患者的 SVT 再通率、任何出血、死亡、肠缺血、门静脉海绵样变性和胃食管静脉曲张进行了汇总和比较。计算了汇总率和风险比（RR）及其 95%置信区间（CI）。评估了研究之间的异质性。共有 16 项研究，包括 698 例急性胰腺炎相关 SVT 患者符合纳入标准。接受治疗性抗凝后，SVT 再通率、任何出血、死亡、肠缺血、门静脉海绵样变性和胃食管静脉曲张的汇总率分别为 44.3%（95%CI=32.3%-56.6%）、10.7%（95%CI=4.9%-18.5%）、13.3%（95%CI=6.9%-21.4%）、16.8%（95%CI=6.9%-29.9%）、21.2%（95%CI=7.5%-39.5%）和 29.1%（95%CI=16.1%-44.1%）。抗凝治疗显著增加了 SVT 再通率（RR=1.69；95%CI=1.29-2.19；<.01），且略微增加了出血风险（RR=1.98；95%CI=0.93-4.22；=0.07）。死亡率（RR=1.42；95%CI=0.62-3.25；=0.40）、肠缺血（RR=2.55；95%CI=0.23-28.16；=0.45）、门静脉海绵样变性（RR=0.51；95%CI=0.21-1.22；=0.13）和胃食管静脉曲张（RR=0.71；95%CI=0.38-1.32；=0.28）在接受和未接受抗凝治疗的患者之间无显著差异。肠缺血的荟萃分析存在统计学异质性，但 SVT 再通、任何出血、死亡、门静脉海绵样变性或胃食管静脉曲张的荟萃分析不存在统计学异质性。抗凝治疗可能有助于急性胰腺炎相关 SVT 的再通，但不能改善生存率。需要进行随机对照试验，以进一步研究此类患者抗凝治疗的临床意义。
