Prophylaxis Against Venous Thromboembolism in Patients with Necrotizing Pancreatitis: Can We Do Better?

Abstract

Our surgical colleagues have provided us with a single center, prospective observational audit of the rate of clinically relevant and radiologically detected venous thromboembolism (VTE), as well as the associated efficacy of standard chemical VTE prophylaxis, in patients with necrotizing pancreatitis. ¹ Maatman T.K. McGuire S.P. Lewellen K.A. et al. A prospective analysis of the mechanisms underlying ineffective deep vein thrombosis prophylaxis in necrotizing pancreatitis. J Am Coll Surg. 2021; 232 : 91-100 Abstract Full Text Full Text PDF Scopus (1) Google Scholar More specifically, they prospectively screened all patients for VTE on a weekly basis, as well as used serum anti-Xa levels to determine what proportion of patients were adequately prophylaxed. This work addresses previous concerns of the underappreciated risk of VTE in patients with necrotizing pancreatitis. ² Roch A.M. Maatman T.K. Carr R.A. et al. Venous thromboembolism in necrotizing pancreatitis: an underappreciated risk. J Gastrointest Surg. 2019; 23 : 2430-2438 Crossref PubMed Scopus (8) Google Scholar Among the 85 patients followed in total (201 screening events), 65% were noted to develop VTE. Significantly more concerning, however, is not the total VTE rate, but instead, the frequency of extremity deep venous thrombosis (DVT). Thirty-eight percent of patients were screened positive with an extremity DVT at a mean of 44 days after the onset of pancreatitis. Although the need to treat mesenteric (splenic, superior mesenteric, and portal venous) VTE continues to be highly debatable in the setting of acute pancreatitis, extremity DVT clearly remains a potential threat to patient outcomes.