Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences

Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer’s V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance ( P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.

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Splanchnic vein thrombosis secondary to severe acute pancreatitis treated with regional anticoagulation via transjugular intrahepatic portosystem stent-shunt

Pancreatology ◽

10.1016/j.pan.2015.12.043 ◽

2016 ◽

Vol 16 (1) ◽

pp. S12

Author(s):

Wei Jiang ◽

Jing Zhou ◽

Lu Ke ◽

Zhihui Tong ◽

Gang Li ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Regional Anticoagulation

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P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

British Journal of Surgery ◽

10.1093/bjs/znab430.254 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

K Thejasvin ◽

Sara-Jane Chan ◽

Chris Varghese ◽

Wei Boon Lim ◽

Gemisha Cheemungtoo ◽

...

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Splenic Vein ◽

Bleeding Complications ◽

Splenic Vein Thrombosis ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Incidence Risk ◽

Necrotising Pancreatitis

Abstract Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

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Predictive factors of splanchnic vein thrombosis in acute pancreatitis: A 6-year single-center experience

Journal of Digestive Diseases ◽

10.1111/1751-2980.12298 ◽

2015 ◽

Vol 16 (12) ◽

pp. 734-740 ◽

Cited By ~ 6

Author(s):

Laurence Toqué ◽

Antoine Hamy ◽

Jean-Francois Hamel ◽

Elodie Cesbron ◽

Pauline Hulo ◽

...

Keyword(s):

Acute Pancreatitis ◽

Predictive Factors ◽

Single Center ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Single Center Experience

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Analysis and predictive factors of splanchnic vein thrombosis in acute pancreatitis

Pancreatology ◽

10.1016/j.pan.2017.05.356 ◽

2017 ◽

Vol 17 (3) ◽

pp. S113-S114

Author(s):

Carlos Marra-Lopez ◽

Federico Bolado ◽

Hector Canaval-Zuleta ◽

Robin Rivera-Irigoin ◽

Francisco Javier Grau-García ◽

...

Keyword(s):

Acute Pancreatitis ◽

Predictive Factors ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis

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Splanchnic vein thrombosis in severe acute pancreatitis: a 2-year, single-institution experience

HPB ◽

10.1111/j.1477-2574.2011.00392.x ◽

2011 ◽

Vol 13 (12) ◽

pp. 860-864 ◽

Cited By ~ 31

Author(s):

Hector Jazmin Gonzelez ◽

Samir J. Sahay ◽

Benny Samadi ◽

Brian Ritchie Davidson ◽

Sakhawat Hussain Rahman

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Single Institution ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis

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Portal Vein Thrombosis Is Associated with an Increased Incidence of Depression and Anxiety Disorders

Journal of Clinical Medicine ◽

10.3390/jcm10235689 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5689

Author(s):

Simon Johannes Gairing ◽

Peter Robert Galle ◽

Jörn M. Schattenberg ◽

Karel Kostev ◽

Christian Labenz

Keyword(s):

Anxiety Disorders ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Cox Regression ◽

Severe Disease ◽

Well Being ◽

Depression And Anxiety ◽

Vein Thrombosis ◽

The Impact ◽

The Relationship

Portal vein thrombosis (PVT) is a severe disease that adversely affects patients’ well-being. Data on the influence of PVT on the occurrence of depression or anxiety disorders are lacking. This study aimed to explore the impact of PVT on the incidence of depression and anxiety disorders diagnoses in a large German primary care cohort over a ten-year period. Patients with PVT were matched to non-PVT individuals by age, sex, yearly consultation frequency, index year and comorbidities in a 1:5 ratio. The primary outcome of the study was the incidence of depression and anxiety disorders. The relationship between PVT and both depression and anxiety disorders was investigated using Cox regression models. We compared 547 patients with PVT with 2735 matched individuals without PVT. Within 5 years of the index date, 17.4% of patients with PVT and 9.3% of non-PVT individuals were diagnosed with depression (p < 0.001). Anxiety disorders were diagnosed in 5.5% and 3.0% of patients with PVT and non-PVT individuals, respectively (p = 0.002). On regression analyses, PVT was positively associated with incident depression (HR 2.01, 95% CI 1.53–2.64, p < 0.001) as well as anxiety disorders (HR 2.16, 95% CI 1.35–3.46, p = 0.001). Regarding depression, this association remained significant in women as well as in men. There was no association between PVT and the incidence of anxiety disorders in women. In conclusion, PVT is associated with the development of depression and anxiety disorders. However, further prospective studies are needed to confirm our findings before definitive recommendations can be made.

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Influence of the placental cord insertion site on the placental mass and the birth weight in dichorionic diamniotic twins

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001843 ◽

2021 ◽

pp. 3-11

Author(s):

Iryna Tepla

Keyword(s):

Birth Weight ◽

Surface Area ◽

Umbilical Cord ◽

Insertion Site ◽

Strong Positive Correlation ◽

Same Sex ◽

Birth Weight Percentile ◽

Negative Effect ◽

The Impact ◽

Umbilical Cord Insertion

The aim of the study was to determine the effect of the displacement of the umbilical cord insertion site from the centre of the placenta on the placental mass and the birth weight of dichorionic diamniotic twins and to consider the importance of the direction of the displacement, as well as to assess the influence of the umbilical cord displacement on the placental mass and the birth weight of dichorionic diamniotic twins taking into account the direction of displacement. Material and methods. The study was performed on 135 dichorionic diamniotic pairs: 68 opposite-sex, 35 same-sex males, and 32 same-sex females. The impact of an absolute cord displacement from the centroid of the placental disc and the direction of its shifting were compared with the birth weight and the placental mass. Results. In the investigated group, a central insertion was revealed in 6 (2.2 %), eccentric – in 224 (83.0 %), marginal – in 31 (11.5 %), and velamentous – in 9 (3.3 %) cases. The first two types of cord insertion are considered to be normal, the third and the fourth are seen as abnormal. The placental mass was in a strong positive correlation with the birth weight (r=0.71, p<0.0001). The placentas with an eccentric cord insertion had a smaller surface area. A negative correlation was established between the displacement of the cord insertion site and the placental mass (r=-0.4284, p<0.0001) as well as the birth weight (r=-0.6115, p<0.0001). The shift along the long axis was of greater importance than in relation to the shorter one. The placental mass and the birth weight were higher in the new-borns with a normal cord insertion site. In the abnormal cord insertion group, 32.5 % of the infants were under the 10th birth weight percentile, in the normal cord insertion group – only 8.3 %. Conclusions. The birth weight of dichorionic diamniotic twins and their placental mass are negatively correlated with the distance of the umbilical cord insertion site from the placental centre. The insertion site displacement along the long axis has a stronger negative effect on the birth weight and the placental mass in comparison with the shifting along the short axis. The placentas with an eccentric cord insertion have a smaller surface area.

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Lack of Association Between the 46/1 JAK2 Haplotype and the Presence of JAK2V617F Mutation In Splanchnic Vein Thrombosis Patients

Blood ◽

10.1182/blood.v116.21.4120.4120 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4120-4120

Author(s):

Eirini G Kouroupi ◽

Bruno Cassinat ◽

Aurelie Plessier ◽

Sylvia Bellucci ◽

Christine Chomienne ◽

...

Keyword(s):

Conflicts Of Interest ◽

Myeloproliferative Neoplasms ◽

Jak2v617f Mutation ◽

Fisher Exact Test ◽

Peripheral Vein ◽

Splanchnic Vein Thrombosis ◽

Vein Thrombosis ◽

Tag Snp ◽

Mutational Status ◽

The Impact

Abstract Abstract 4120 Aim: The majority of myeloproliferative neoplasms (MPN), i.e. Polycythemia vera (PV), Essential Thrombocytemia (ET) and Primary Myelofibrosis, are characterized by the presence of the acquired JAK2V617F gene mutation. Recent studies revealed that the 46/1 or “GGCC” haplotype located in the JAK2 gene is strongly associated with the development of a JAK2V617F positive MPN. However, this particular haplotype was also detected in excess in JAK2V617F negative MPN carrying mutations across JAK2 exon 12 or the MPL gene, suggesting that this germline genetic variation increases the risk of developing a MPN regardless of the acquisition of one particular mutation. A MPN is found in approximately half of the patients presenting with Splanchnic Vein Thrombosis (SVT) and JAK2V617F mutation is present in virtually all of these MPN patients. In this study we sought to clarify the impact of the JAK2 46/1 haplotype on the susceptibility to SVT. Patients and Methods: Peripheral blood was obtained after informed consent; following DNA extraction we proceeded to genotyping using commercially available TaqMan SNP genotyping assays for one tag SNP (rs10974944) which is in complete linkage disequilibrium with the 46/1 haplotype. Results were confirmed using another tag SNP (rs1234867). The study was performed on 170 patients with SVT, 58 patients with peripheral vein thrombosis and 31 patients with JAK2V617F positive PV. Results: In the 170 patients with SVT the frequency of G-allele that stands for the 46/1 haplotype was 0.28 (CC n=89; C/G n=67; G/G n=14), not significantly different from that of the published population controls (n=1500) from the Welcome Trust Case Control Consortium WTCCC (0.24; p=0.11 by the Fisher exact test). The frequency of the 46/1 haplotype in 58 patients with peripheral vein thrombosis was also similar to that of the WTCCC (0.24). However, the frequency of the 46/1 haplotype in SVT patients was significantly different from its frequency in a group of 31 patients with JAK2V617F positive PV (0.52; p=0.0005). When we analysed SVT patients according to their JAK2 mutational status, we found no difference in the frequency of the 46/1 haplotype between the JAK2V617F positive patients (0.27; n=75) and the JAK2V617F negative patients (0.28; n=95) (p=0.90). Of note, a JAK2 allele burden greater than 50% was observed in 11% of patients with JAK2V617F positive SVT and 45% of patients with JAK2V617F positive PV. Conclusions: In this large cohort of 170 patients with SVT the frequency of the 46/1 haplotype was not different from the cohort of controls of the WTCCC. This result suggests that the 46/1 haplotype is not a susceptibility locus for the development of SVT. Moreover, this haplotype was not overrepresented in the group of SVT patients harbouring a JAK2V617F mutation compared to JAK2V617F negative patients. This result is in apparent contradiction with the hypothesis that the 46/1 haplotype predisposes to the acquisition of JAK2V617F mutation or of a MPN, in agreement with recent studies reporting almost identical 46/1 frequencies between V617F-negative patients and V617F-positive patients with low mutation burden (i.e. <50%), which is the case of SVT patients in this series. Disclosures: No relevant conflicts of interest to declare.

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