| Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis |
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| 作者姓名： | William Norton Gabija Lazaraviciute George Ramsay Irene Kreis Irfan Ahmed Mohamed Bekheit |
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| 作者单位： | Department of General Surgery;Rowett Institute of Nutrition and Health;Clinical Effectiveness Unit;Department of Surgery |
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| 摘 要： | Background:Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality.A consequence of severe acute pancreatitis is thrombus in the splanchnic veins.These thrombi can potentially lead to bowel ischemia or hepatic failure.However,another complication of severe acute pancreatitis is retroperitoneal bleeding.At this time,it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit.A systematic review might clarify this question.Data sources:A two-fold search strategy(one broad and one precise)looked at all published literature.The review was registered on PROSPERO(ID:CRD42018102705).MEDLINE,EMBASE,PubMed,Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed indepen-dently by two researchers.Any disagreement was reviewed by a third independent researcher.Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications.Results:Of 1462 papers assessed,a total of 16 papers were eligible for inclusion.There were no ran-domized controlled trials,2 were case series,5 retrospective single-center studies and 9 case reports.There were a total of 198 patients in these studies of whom 92(46.5%)received anticoagulation therapy.The rates of recanalization of veins in the treated and non-treated groups was 14%and 11%and bleeding complications were 16%and 5%,respectively.However,the included studies were too heterogeneous to undertake a meta-analysis.Conclusions:The systematic review highlights the lack evidence addressing this clinical question.There-fore a randomized controlled trial would be appropriate to undertake.
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| 关 键 词： | SEVERE acute PANCREATITIS SPLANCHNIC VEIN THROMBOSIS ANTICOAGULANT therapy |
| 收稿时间： | 6 August 2019 |
Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis |
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| William Norton,Gabija Lazaraviciute,George Ramsay,Irene Kreis,Irfan Ahmed,Mohamed Bekheit.Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis[J].Hepatobiliary & pancreatic diseases international : HBPD INT,2020,19(2):116-121. |
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| Institution: | 1. Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;2. Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK;3. Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln''s Inn Fields, Holborn, London WC2A 3PE, UK;4. Department of Surgery, El Kabbary Hospital, El Kabbary, Alexandria, Egypt;1. School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;2. Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China;3. International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai 200438, China;4. National Center for Liver Cancer, Shanghai 201805, China;5. Biliary Tract Department II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;6. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;7. Biliary Tract Department I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;8. Department of Special Medical Care & Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;9. Department of Oncology, Shanghai Cancer Center and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China;1. Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;2. Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;3. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;4. Department of Imaging, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;1. Department of Biological Sciences, Hunter College of The City University of New York, New York, NY 10065, USA;2. The Graduate Center Departments of Biology and Biochemistry, The City University of New York, New York, NY 10016, USA;3. Hunter College Center for Cancer Health Disparities Research (CCHDR), New York, NY 10065, USA;4. Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA |
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| Abstract: | Background: Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality. A consequence of severe acute pancreatitis is thrombus in the splanchnic veins. These thrombi can potentially lead to bowel ischemia or hepatic failure. However, another complication of severe acute pancreatitis is retroperitoneal bleeding. At this time, it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit. A systematic review might clarify this question. Data sources: A two-fold search strategy(one broad and one precise) looked at all published literature. The review was registered on PROSPERO(ID: CRD42018102705). MEDLINE, EMBASE, Pub Med, Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed independently by two researchers. Any disagreement was reviewed by a third independent researcher. Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications. Results: Of 1462 papers assessed, a total of 16 papers were eligible for inclusion. There were no randomized controlled trials, 2 were case series, 5 retrospective single-center studies and 9 case reports. There were a total of 198 patients in these studies of whom 92(46.5%) received anticoagulation therapy. The rates of recanalization of veins in the treated and non-treated groups was 14% and 11% and bleeding complications were 16% and 5%, respectively. However, the included studies were too heterogeneous to undertake a meta-analysis. Conclusions: The systematic review highlights the lack evidence addressing this clinical question. Therefore a randomized controlled trial would be appropriate to undertake. |
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