Abstract Number: PB1174
Meeting: ISTH 2021 Congress
Background: Splanchnic venous thrombosis (SVT) is a well-established complication of acute pancreatitis (AP) and may affect splenic, portal and superior mesenteric veins, either isolated or in combination. Its pathogenesis is closely associated to inflammation, leading to cellular infiltration, formation of pancreatic/peripancreatic collections that contribute to venous stasis and systemic activation of haemostasis.
Aims: Description of a case of SVT AP-associated.
Methods: Collection of clinical data in SClínico® application.
Results: A 47-year-old female patient, with antecedents of previous AP secondary to hypertriglyceridemia, was admitted to emergency department with pain in upper quadrants of abdomen, radiating towards the back, with nausea and vomiting, over the past few hours. Through clinical, analytical and imaging evaluation, the diagnosis of AP secondary to hypertriglyceridemia was established. The patient was hospitalized and, 4 days later, due to clinical worsening, a computed tomography (CT) was performed, revealing splenic vein thrombosis and pancreatic necrosis. Enoxaparin in therapeutic dose was initiated. The patient remained hospitalized for 18 days and enoxaparin was replaced by rivaroxaban 20mg once daily at discharge. Three months later, CT showed persistence of thrombosis, with perigastric/perisplenic collateral circulation. Considering this extensive collateral circulation, complete recanalization was no longer expected. Anticoagulation was maintained for a total period of 6 months.
Conclusions: Management of thrombosis in AP remains challenging. There’s no consensus on anticoagulation in this setting, with some studies concluding that there’s no difference in collateral formation, recanalization and mortality, whether anticoagulation had been prescribed or not. These findings emphasize the predominant role of inflammation, increasing uncertainty of risk/benefit ratio of anticoagulation. When portal and superior mesenteric veins are affected, anticoagulation seems a reasonable attitude, considering the risk of hepatic decompensation and bowel ischemia. More studies are needed to consolidate this evidence and to establish well-defined recommendations in other situations (e.g., isolated thrombosis of splenic vein, as in this case).
To cite this abstract in AMA style:Vieira L, Lopes S, Pombal R, Neto R, Magalhães A, Figueiredo M. Does Anticoagulation Affect Outcome of Splenic Vein Thrombosis in Acute Pancreatitis? [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/does-anticoagulation-affect-outcome-of-splenic-vein-thrombosis-in-acute-pancreatitis/. Accessed September 24, 2021.
« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/does-anticoagulation-affect-outcome-of-splenic-vein-thrombosis-in-acute-pancreatitis/