Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 13, Number 1, February 2020, pages 25-31

Splanchnic Venous Thrombosis in Acute Pancreatitis: Does Anticoagulation Affect Outcome?

**Table 1.** Clinical Features in SVT and Non-SVT Groups
Variables	SVT (n = 24)	Non-SVT (n = 81)	Total (n = 105)	P value
SVT: splanchnic venous thrombosis; BMI: body mass index; PEP: post-ERCP pancreatitis; CRP: C-reactive protein; BUN: blood urea nitrogen; APFC: acute pancreatic fluid collection; WOPN: walled-off pancreatic necrosis; ANC: acute necrotic collection; SIRS: systemic inflammatory response syndrome; BISAP: bedside index of severity in pancreatitis; mCTSI: modified computed tomography scan severity index; APACHEII: acute physiology and chronic health evaluation-II.
Age (years)	36.62 ± 6.49	41.56 ± 13.85	39.12 ± 13.33	0.09
Sex
Male	19 (79.17%)	51 (62.96%)	70 (66.67%)
Female	5 (20.8%)	30 (37.03%)	35 (33.33%)	0.21
BMI (kg/m²)	20.03 ± 2.25	22.49 ± 4.72	21.93 ± 4.40	0.01
Etiology
Alcoholic	21 (87.5%)	27 (33.3%)	48 (45.7%)
Gallstone	0 (0%)	27 (33.3%)	27 (25.7%)
Idiopathic	0 (0%)	15 (18.5%)	15 (14.3%)	< 0.001
PEP	0 (0%)	3 (3.7%)	3 (2.9%)
Other	3 (12.5%)	9 (11.1%)	12 (11.4%)
Amylase (U/L)	493.00 ± 206.92	451.56 ± 150.61	461.03 ± 165	0.282
Hematocrit (%)	38.99 ± 10.74	38.00 ± 6.01	38.23 ± 7.31	0.565
CRP (mg/dL)	242.01 ± 172.57	122.76 ± 82.10	150.02 ± 119.59	< 0.001
BUN (mg/dL)	13.88 ± 9.20	14.04 ± 7.60	14.00 ± 7.94	0.929
Pleural effusion	21 (87.5%)	24 (29.6%)	45 (42.9%)	< 0.001
Ascites	12 (50%)	21 (25.9%)	33 (31.4%)	0.026
Local complications	24 (100%)	42 (51.9%)	66 (62.9%)	< 0.001
APFC	0 (0%)	24 (29.6%)	24 (22.9%)
Pseudocyst	12 (50%)	9 (11.1%)	21 (20%)
WOPN	9 (37.5%)	3 (3.7%)	12 (11.4%)
ANC + APFC	3 (12.5%)	3 (3.7%)	6 (5.7%)
ANC	0 (0%)	3 (3.7%)	3 (2.9%)
SIRS	21 (87.5%)	45 (55.6%)	66 (62.9%)	0.004
BISAP	2.00 ± 0.88	1.00 ± 0.91	1.23 ± 0.99	< 0.001
mCTSI	7.25 ± 1.42	4.00 ± 2.32	4.74 ± 2.55	< 0.001
Revised Atlanta classification
Mild	0 (0%)	36 (44.4%)	36 (34.3%)
Moderate	18 (75%)	42 (51.9%)	60 (57.1%)	< 0.001
Severe	6 (25%)	3 (3.7%)	9 (8.6%)
APCHE II	6.75 ± 4.11	4.37 ± 3.88	4.91 ± 4.04	0.011
Organ failure	9 (37.5%)	9 (11.1%)	18 (17.1%)	0.003
Intervention	15 (62.5%)	6 (7.4%)	21 (20%)	< 0.001
Mortality	3 (12.5%)	6 (7.4%)	9 (8.6%)	0.424

Table 1. Clinical Features in SVT and Non-SVT Groups

Variables

SVT (n = 24)

Non-SVT (n = 81)

Total (n = 105)

P value

SVT: splanchnic venous thrombosis; BMI: body mass index; PEP: post-ERCP pancreatitis; CRP: C-reactive protein; BUN: blood urea nitrogen; APFC: acute pancreatic fluid collection; WOPN: walled-off pancreatic necrosis; ANC: acute necrotic collection; SIRS: systemic inflammatory response syndrome; BISAP: bedside index of severity in pancreatitis; mCTSI: modified computed tomography scan severity index; APACHEII: acute physiology and chronic health evaluation-II.

Age (years)

36.62 ± 6.49

41.56 ± 13.85

39.12 ± 13.33

0.09

Sex

Male

19 (79.17%)

51 (62.96%)

70 (66.67%)

Female

5 (20.8%)

30 (37.03%)

35 (33.33%)

0.21

BMI (kg/m²)

20.03 ± 2.25

22.49 ± 4.72

21.93 ± 4.40

0.01

Etiology

Alcoholic

21 (87.5%)

27 (33.3%)

48 (45.7%)

Gallstone

0 (0%)

27 (33.3%)

27 (25.7%)

Idiopathic

0 (0%)

15 (18.5%)

15 (14.3%)

< 0.001

PEP

0 (0%)

3 (3.7%)

3 (2.9%)

Other

3 (12.5%)

9 (11.1%)

12 (11.4%)

Amylase (U/L)

493.00 ± 206.92

451.56 ± 150.61

461.03 ± 165

0.282

Hematocrit (%)

38.99 ± 10.74

38.00 ± 6.01

38.23 ± 7.31

0.565

CRP (mg/dL)

242.01 ± 172.57

122.76 ± 82.10

150.02 ± 119.59

< 0.001

BUN (mg/dL)

13.88 ± 9.20

14.04 ± 7.60

14.00 ± 7.94

0.929

Pleural effusion

21 (87.5%)

24 (29.6%)

45 (42.9%)

< 0.001

Ascites

12 (50%)

21 (25.9%)

33 (31.4%)

0.026

Local complications

24 (100%)

42 (51.9%)

66 (62.9%)

< 0.001

APFC

0 (0%)

24 (29.6%)

24 (22.9%)

Pseudocyst

12 (50%)

9 (11.1%)

21 (20%)

WOPN

9 (37.5%)

3 (3.7%)

12 (11.4%)

ANC + APFC

3 (12.5%)

3 (3.7%)

6 (5.7%)

ANC

0 (0%)

3 (3.7%)

3 (2.9%)

SIRS

21 (87.5%)

45 (55.6%)

66 (62.9%)

0.004

BISAP

2.00 ± 0.88

1.00 ± 0.91

1.23 ± 0.99

< 0.001

mCTSI

7.25 ± 1.42

4.00 ± 2.32

4.74 ± 2.55

< 0.001

Revised Atlanta classification

Mild

0 (0%)

36 (44.4%)

36 (34.3%)

Moderate

18 (75%)

42 (51.9%)

60 (57.1%)

< 0.001

Severe

6 (25%)

3 (3.7%)

9 (8.6%)

APCHE II

6.75 ± 4.11

4.37 ± 3.88

4.91 ± 4.04

0.011

Organ failure

9 (37.5%)

9 (11.1%)

18 (17.1%)

0.003

Intervention

15 (62.5%)

6 (7.4%)

21 (20%)

< 0.001

Mortality

3 (12.5%)

6 (7.4%)

9 (8.6%)

0.424

**Table 2.** Clinical Features and Outcome Between AC and Non-AC Groups
Variables	Non-AC (n = 12)	AC (n = 12)	Total (n = 24)	P value
AC: anticoagulation; SplV: splenic vein; PV: portal vein; SMV: superior mesenteric vein.
Number of veins
Single	10 (83.3%)	1 (8.3%)	11 (45.8%)
Double	2 (16.7%)	2 (16.7%)	4 (16.7%)	< 0.001
Triple	0 (0%)	9 (75%)	9 (37.5%)
Type of vein
SplV	10 (83.3%)	1 (8.3%)	11 (45.8%)
SplV + PV	2 (16.7%)	2 (16.7%)	4 (16.7%)	< 0.001
SplV + PV + SMV	0 (0%)	9 (75%)	9 (37.5%)
Bowel ischemia	0 (0%)	4 (33.3%)	4 (16%)	0.093
Hepatic decompensation	0 (0%)	3 (25%)	3 (12%)	0.217
Bleeding	0 (0%)	3 (25%)	3 (12%)	0.217
Varices	4 (33.3%)	3 (25%)	7 (29.2%)	1.000
Collateral formation	3 (25%)	3 (25%)	6 (25%)	1.000
Portal cavernoma	4 (33.3%)	3 (25%)	7 (29.2%)	0.653
Recanalization	5 (41.7%)	6 (50%)	11 (45.8%)	0.682
Mortality	2 (16.7%)	1 (8.3%)	3 (12.5%)	1.000

Table 2. Clinical Features and Outcome Between AC and Non-AC Groups

Variables

Non-AC (n = 12)

AC (n = 12)

Total (n = 24)

P value

AC: anticoagulation; SplV: splenic vein; PV: portal vein; SMV: superior mesenteric vein.

Number of veins

Single

10 (83.3%)

1 (8.3%)

11 (45.8%)

Double

2 (16.7%)

4 (16.7%)

< 0.001

Triple

0 (0%)

9 (75%)

9 (37.5%)

Type of vein

SplV

10 (83.3%)

1 (8.3%)

11 (45.8%)

SplV + PV

2 (16.7%)

4 (16.7%)

< 0.001

SplV + PV + SMV

0 (0%)

9 (75%)

9 (37.5%)

Bowel ischemia

0 (0%)

4 (33.3%)

4 (16%)

0.093

Hepatic decompensation

0 (0%)

3 (25%)

3 (12%)

0.217

Bleeding

0 (0%)

3 (25%)

3 (12%)

0.217

Varices

4 (33.3%)

3 (25%)

7 (29.2%)

1.000

Collateral formation

3 (25%)

6 (25%)

1.000

Portal cavernoma

4 (33.3%)

3 (25%)

7 (29.2%)

0.653

Recanalization

5 (41.7%)

6 (50%)

11 (45.8%)

0.682

Mortality

2 (16.7%)

1 (8.3%)

3 (12.5%)

1.000

**Table 3.** Literature on Splanchnic Venous Thrombosis and Anticoagulation in Acute Pancreatitis
Author	Harris et al, 2013 [7]	Gonzelez et al, 2011 [8]	Easler et al, 2014 [9]	Present study
SVT: splanchnic venous thrombosis; SplV: splenic vein; PV: portal vein; SMV: superior mesenteric vein; AC: anticoagulation; DVT: deep vein thrombosis; PVT: portal vein thrombosis.
Study design	Retrospective	Prospective Retrospective	Prospective Retrospective	Prospective
Sample size	2,454	127	162	105
Rate of SVT occurrence	45/2,454 (1.8%)	24/127 (18.9%)	22/162 (14%)	24/105 (22.8%)
Predominant etiology	Gallstone	Alcohol	Gallstone	Alcohol
Local complications	Peripancreatic collection in 24/45 (53.33%); necrotizing pancreatitis in 26/45 (57.78%)	19/22 (86.36%)	21/22 (95.45%)	24/24 (100%)
Clinical features of SVT
Most common vessel involved	Splenic vein in 30/45 (67%)	Splenic vein 14/20 (70%)	Splenic vein 19/22 (86%)	Splenic vein 24/24 (100%)
Bowel ischemia	2/45 (4.4%)	1/20 (5%)	-	4/24 (16.67%)
Hepatic decompensation	-	1/20 (5%)	-	3/24 (12.5%)
Bleeding	7/45 (15.56%)	-	2/22 (9.09%)	3/24 (12.5%)
Development of collateral/varices/portal cavernoma	Collaterals or varices 21/45 (46.67%)	Collaterals in 10/20 (50%); portal cavernoma in 3/20 (15%)	Collaterals in 19/22 (86%); varices in 6/22 (27%)	Collaterals in 6/24 (25%); varices in 7/24 (29.17%); portal cavernoma in 7/24 (29.17%)
Recanalization	5/45 (11.11%)	7/20 (35%)	2/22 (9%)	11/24 (45.83%)
Mortality	3/45 (6.67%)	1/20 (5%)	1/22 (5%)	3/24 (12.5%)
Number of patients anticoagulated	17/45 (37.78%)	4/20 (20%)	6/22 (27.27%)	12/24 (50%)
Indication for anticoagulation	Acute PV thrombosis, thrombus extension, DVT or pulmonary embolism	Acute PVT with or without SplV thrombosis or thrombus extension	Deep vein thrombosis, stroke	Bowel ischemia, hepatic decompensation, SplV + PV + SMV thrombosis, pulmonary embolism
Outcome with AC
Bleeding	2/17 (12%)	-	2/6 (33.33%)	3/12 (25%)
Development of collateral, varices and portal cavernoma	Varices or collaterals 6/17 (35%)	-	Collaterals 5/6 (83.33%)	Collaterals in 3/12(25%); varices in 3/12 (25%), portal cavernoma in 3/12 (25%)
Recanalization	2/17 (12%)	2/4 (50%)	0/6 (0%)	6/12 (50%)

Table 3. Literature on Splanchnic Venous Thrombosis and Anticoagulation in Acute Pancreatitis

Author

Harris et al, 2013 [7]

Gonzelez et al, 2011 [8]

Easler et al, 2014 [9]

Present study

SVT: splanchnic venous thrombosis; SplV: splenic vein; PV: portal vein; SMV: superior mesenteric vein; AC: anticoagulation; DVT: deep vein thrombosis; PVT: portal vein thrombosis.

Study design

Retrospective

Prospective Retrospective

Prospective

Sample size

2,454

127

162

105

Rate of SVT occurrence

45/2,454 (1.8%)

24/127 (18.9%)

22/162 (14%)

24/105 (22.8%)

Predominant etiology

Gallstone

Alcohol

Gallstone

Alcohol

Local complications

Peripancreatic collection in 24/45 (53.33%); necrotizing pancreatitis in 26/45 (57.78%)

19/22 (86.36%)

21/22 (95.45%)

24/24 (100%)

Clinical features of SVT

Most common vessel involved

Splenic vein in 30/45 (67%)

Splenic vein 14/20 (70%)

Splenic vein 19/22 (86%)

Splenic vein 24/24 (100%)

Bowel ischemia

2/45 (4.4%)

1/20 (5%)

4/24 (16.67%)

Hepatic decompensation

1/20 (5%)

3/24 (12.5%)

Bleeding

7/45 (15.56%)

2/22 (9.09%)

3/24 (12.5%)

Development of collateral/varices/portal cavernoma

Collaterals or varices 21/45 (46.67%)

Collaterals in 10/20 (50%); portal cavernoma in 3/20 (15%)

Collaterals in 19/22 (86%); varices in 6/22 (27%)

Collaterals in 6/24 (25%); varices in 7/24 (29.17%); portal cavernoma in 7/24 (29.17%)

Recanalization

5/45 (11.11%)

7/20 (35%)

2/22 (9%)

11/24 (45.83%)

Mortality

3/45 (6.67%)

1/20 (5%)

1/22 (5%)

3/24 (12.5%)

Number of patients anticoagulated

17/45 (37.78%)

4/20 (20%)

6/22 (27.27%)

12/24 (50%)

Indication for anticoagulation

Acute PV thrombosis, thrombus extension, DVT or pulmonary embolism

Acute PVT with or without SplV thrombosis or thrombus extension

Deep vein thrombosis, stroke

Bowel ischemia, hepatic decompensation, SplV + PV + SMV thrombosis, pulmonary embolism

Outcome with AC

Bleeding

2/17 (12%)

2/6 (33.33%)

3/12 (25%)

Development of collateral, varices and portal cavernoma

Varices or collaterals 6/17 (35%)

Collaterals 5/6 (83.33%)

Collaterals in 3/12(25%); varices in 3/12 (25%), portal cavernoma in 3/12 (25%)

Recanalization

2/17 (12%)

2/4 (50%)

0/6 (0%)

6/12 (50%)