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Splanchnic vein thrombosis in necrotizing pancreatitis: a post-hoc analysis of a nationwide prospective cohort.
Sissingh, Noor J; Timmerhuis, Hester C; Groen, Jesse V; de Jong, Mike J P; Besselink, Marc G; Boekestijn, Bas; Bollen, Thomas L; Bonsing, Bert A; Bouwense, Stefan A W; Hazen, Wouter L; Klok, Frederikus A; van Santvoort, Hjalmar C; van Eijck, Casper H J; Verdonk, Robert C; Mieog, J Sven D; van Hooft, Jeanin E.
Afiliação
  • Sissingh NJ; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands. Electronic address: n.j.sissingh@lumc.nl.
  • Timmerhuis HC; Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
  • Groen JV; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  • de Jong MJP; Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
  • Besselink MG; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands.
  • Boekestijn B; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
  • Bollen TL; Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
  • Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  • Bouwense SAW; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
  • Hazen WL; Department of Gastroenterology and Hepatology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands.
  • Klok FA; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
  • van Santvoort HC; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
  • van Eijck CHJ; Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
  • Verdonk RC; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
  • Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  • van Hooft JE; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.e.van_hooft@lumc.nl.
HPB (Oxford) ; 26(4): 548-557, 2024 Apr.
Article em En | MEDLINE | ID: mdl-38336603
ABSTRACT

BACKGROUND:

Treatment guidelines for splanchnic vein thrombosis in necrotizing pancreatitis are lacking due to insufficient data on the full clinical spectrum.

METHODS:

We performed a post-hoc analysis of a nationwide prospective necrotizing pancreatitis cohort. Multivariable analyses were used to identify risk factors and compare the clinical course of patients with and without SVT.

RESULTS:

SVT was detected in 97 of the 432 included patients (22%) (median onset 4 days). Risk factors were left, central, or subtotal necrosis (OR 28.52; 95% CI 20.11-40.45), right or diffuse necrosis (OR 5.76; 95% CI 3.89-8.51), and younger age (OR 0.94; 95% CI 0.90-0.97). Patients with SVT had higher rates of bleeding (n = 10,11%) and bowel ischemia (n = 4,4%) compared to patients without SVT (n = 14,4% and n = 2,0.6%; OR 3.24; 95% CI 1.27-8.23 and OR 7.29; 95% CI 1.31-40.4, respectively), and were independently associated with ICU admission (adjusted OR 2.53; 95% CI 1.37-4.68). Spontaneous recanalization occurred in 62% of patients (n = 40/71). Radiological and clinical outcomes did not differ between patients treated with and without anticoagulants.

DISCUSSION:

SVT is a common and early complication of necrotizing pancreatitis, associated with parenchymal necrosis and younger age. SVT is associated with increased complications and a worse clinical course, whereas anticoagulant use does not appear to affect outcomes.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pancreatite Necrosante Aguda / Trombose Venosa Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pancreatite Necrosante Aguda / Trombose Venosa Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article