Systemic anticoagulation is associated with decreased mortality and morbidity in acute pancreatitis |
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| Affiliation: | 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA;2. Division of Epidemiology, Mayo Clinic, Jacksonville, FL, USA;3. Division of Biostatistics, Mayo Clinic, Jacksonville, FL, USA;4. Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA;1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;2. Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea;1. Oncology Pathology, Faculty of Medicine, Kagawa University, Japan;2. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Japan;3. Department of Radiology, Faculty of Medicine, Kagawa University, Japan;4. Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Japan;5. Department of Hygiene, Faculty of Medicine, Kagawa University, Japan;6. Department of Pathology II, Kochi University, Japan;7. Division of Diagnostic Pathology, Ehime University Hospital, Japan;8. Division of Pathology, Tokushima University Hospital, Japan;9. Department of Pathology, Japanese Red Cross Medical Center, Japan;10. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Japan;11. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, USA;1. Department of Anatomical Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA;2. Department Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA;3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA;4. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA;5. Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA;1. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;3. Division of Hematology and Oncology, Children''s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran;1. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Pittsburgh, PA, USA;2. Pittsburgh Center for Pain Research, School of Medicine, University of Pittsburgh, PA, USA;3. Department of Neurobiology, School of Medicine, University of Pittsburgh, PA, USA;4. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA;5. Saint Louis University, Saint Louis, MO, USA;6. Brigham and Women''s Hospital, Boston, MA, USA;7. The Ohio State University Wexner Medical Center, Columbus, OH, USA;8. Medical University of South Carolina, Charleston, SC, USA;9. Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA;10. Section of Gastroenterology and Hepatology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA;11. Department of Internal Medicine, Miami Cancer Institute, Gastro Health, Miami, FL, USA;12. Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA;13. Indiana University School of Medicine, Indianapolis, IN, USA;14. Departments of Cell Biology & Physiology, and Human Genetics, University of Pittsburgh, PA, USA |
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| Abstract: | Background/objectivesAcute pancreatitis (AP) is a procoagulant state, and markers of coagulopathy are associated with AP severity. We aimed to explore the association of systemic anticoagulation therapy before AP onset with the inpatient outcomes of patients with acute pancreatitis.MethodsThis case-control, retrospective study used data from the Nationwide Inpatient Sample (Jan 2014–Dec 2016). We used medical coding data to identify patients with a principal diagnosis of AP who were receiving systemic anticoagulation therapy. Patients with anticoagulation were matched to those without it on the propensity for having anticoagulation. The propensity for having anticoagulation was estimated using a logistic regression model, matching for age, gender, race, median household income for patients' zip code, Charlson comorbidity score, region of hospital, location of hospital (urban/rural), teaching status of hospital, if admission day was on a weekend, pancreatic cancer class, obesity, tobacco usage. Secondary outcomes were inpatient outcomes and hospital expenditures.ResultsA total of 190,474 patients admitted for acute pancreatitis were identified, out of which 7827 patients were on anticoagulation. After propensity matching, 5776 matched pairs were successfully identified. Patients with AP on anticoagulation tended to have lower risk for ICU admission, acute kidney injury, organ failure or inpatient mortality. However, the group with anticoagulation had longer hospital length of stay and higher hospital costs.ConclusionsAnticoagulation therapy may have a pivotal role in the pathogenesis and progression of AP. These data suggest a potential therapeutic role for anticoagulants in AP. Further studies are needed to better understand these observations. |
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| Keywords: | Acute pancreatitis Anticoagulation NIS Outcomes |
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