Peripheral and splanchnic venous thromboembolism in acute and infected necrotizing pancreatitis: A systematic review and meta-analysis.
Vikram Rajagopalan, Sanjana Putta, Ujwala Pamidimukkala et al.
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In 30 seconds
This systematic review and random-effects meta-analysis pooled venous thromboembolism incidence after acute necrotizing pancreatitis, including an infected-necrosis subgroup. Across 24 studies and 4243 patients, pooled incidence was 34% (95% CI: 26%-42%) for splanchnic vein thrombosis and 14% (95% CI: 4%-28%) for extremity DVT; pulmonary embolism incidence was 4% (95% CI: 2-8%). In patients with infected necrosis, splanchnic thrombosis incidence was higher, at 53% (95% CI: 34%-72%). The authors call for prospective studies to clarify higher-risk subgroups and anticoagulation dosing.
Key findings
- Splanchnic vein thrombosis had a pooled incidence of 34% (95% CI: 26%-42%) across the included studies.
- In the infected-necrosis subgroup, pooled splanchnic vein thrombosis incidence was 53% (95% CI: 34%-72%).
- Pooled incidence was 14% (95% CI: 4%-28%) for extremity DVT and 4% (95% CI: 2-8%) for pulmonary embolism.
- The splenic vein was the most commonly involved splanchnic vein, with an incidence of 20% (95% CI: 12%-29%).
Why it matters
The pooled estimates indicate that thrombosis, particularly in the splanchnic circulation, is a substantial complication in acute necrotizing pancreatitis, with higher reported incidence in infected necrosis. These findings help frame the burden of VTE in this population, while the marked heterogeneity across studies means the estimates should not be treated as precise predictions for individual patients.
What to keep in mind
Incidence estimates showed substantial heterogeneity across studies (I 2 values were high), limiting the precision and generalisability of pooled estimates. The review also identifies a need for prospective cohort studies.