Factors affecting the development and recanalization of venous thrombosis in patients with necrotizing pancreatitis

OBJECTIVE Acute pancreatitis is a disease that occurs with inflammation of the pancreas parenchyma and has local and systemic effects. Necrotizing pancreatitis is a severe form of pancreatitis which has pancreatic necrosis due to destruction of the pancreas parenchyma. It is known that venous thrombosis, a regional complication of pancreatitis, is frequently seen in necrotizing pancreatitis and increases morbidity. Many parameters play a role in the development of venous thrombosis and its etiology is not fully known. The place of anticoagulant drugs used in its treatment is controversial and a complete consensus has not been achieved in the literature. In our study, we aimed to determine the factors affecting the development and recanalization of venous thrombosis, to clarify the treatment management, and thus to reduce the morbidities that may arise in necrotizing pancreatitis. MATERIALS AND METHODS One hundred twenty-one patients diagnosed with necrotizing pancreatitis, who applied to our clinic between July 2013 and August 2022, were evaluated retrospectively. All the patients' sociodemographic and clinical characteristics, habits, comorbidities, medications, laboratory values, computed tomography findings that were gathered on admission and follow-up were examined. The relationship of these parameters with the development of splanchnic venous thrombosis and recanalization was investigated. The role of anticoagulant drug use in the treatment of thrombosis and its effect on recanalization were examined. RESULTS The mean age of the patients was 54.25 years and 58.7% were male and 41.3% were female. It was determined that splanchnic venous thrombosis developed in 51 (42.1%) of all 121 patients. While the development of thrombosis was partial in 24 patients (47.1%) and total in 27 patients (52.9%). Recanalization was detected in 18 (35.3%) of 51 patients which had thrombosis before. When the computed tomography scans of the patients who developed thrombosis were examined, it was observed that the incidence of thrombosis increased as the necrosis ratio of pancreas parenchyma and the computed tomography severity index increased. Recanalization rate was found to be lower in case of total thrombosis (p<0.001). It was observed that none of the diabetic patients with venous thrombosis were recanalized and the patients who were recanalized did not have diabetes (p=0.019). While factor 8 and ristocetin cofactor levels were found to be higher in patients with recanalization; activated protein C resistance level was found to be lower. There was no significant difference in the rates of thrombosis development according to the use of anticoagulants (p=0.239). And also, there was no significant difference in recanalization rates according to the use of anticoagulants in patients who developed thrombosis before (p=0.438). CONCLUSION The clinical course of necrotizing pancreatitis is a dynamic and complex process, and the development of venous thrombosis is closely related to the severity and duration of the inflammation. In this process, one of the best measurements of the inflammation is the computed tomography findings together with the computed tomography severity index scoring system. Recanalization in splanchnic vein thrombosis due to necrotizing pancreatitis primarily depends on the regression of inflammation and the benefit of anticoagulant treatment is not observed. In the presence of diabetes, recanalization becomes difficult.