Acute Pancreatitis (AP) is a common gastrointestinal disease with an incidence of 34 per 100,000 and mortality of up to 30% in its severe form. Frequently, AP is complicated locally and systemically. Splanchnic Venous Thrombosis (SVT) is a well-known local vascular complication of AP involving the portal vein (PV), the splenic vein (SV), and the superior mesenteric vein (SMV) in combination or alone.[1]

Splanchnic vein thrombosis occurs in approximately 16.6–22.6% of patients with acute pancreatitis. It often presents with non-specific chronic abdominal pain and can lead to significant complications due to portal hypertension. These include variceal bleeding, splenomegaly, and, in more severe cases, bowel ischemia resulting from impaired venous drainage. Early recognition and appropriate management are crucial to prevent long-term morbidity.[2]

The aim is to study and analyze pancreatitis-related Splanchnic Venous Thrombosis patients' epidemiological data, anticoagulant therapy and characteristics at the Institute of Pancreatic Diseases, Semmelweis University.

At the Institute, we analysed 1,141 patients with AP admitted between January 2022, and February 2024. We identified 45 cases of pancreatitis-related thrombosis, and 26 cases were included for detailed analysis.

Out of 1,141 patients, 26 were diagnosed with pancreatitis-related SVT. Among these, 19 (73%) were male and 7 (27%) were female and 19 patients experienced moderate acute pancreatitis (AP), while 7 had severe AP. Mean age of the patient population was 48.3 years (SD 13.5), with male patients 44.7 years (SD 10.2) and female patients 58 years (SD 16.2). Average length of hospitalization was 14.5 days (SD10.4). The splenic vein (SpV) was the most affected vessel, involved in 11 patients, followed by Superior Mesenteric Vein (SMV) in 3 patients, portal vein (PV) in 2 patients and 10 patients with two or more vessel involved of SpV, SMV, and PV. In 26 patients, 24 received low molecular weight heparin (LMWH), while 2 received direct oral anticoagulants (DOAC) during hospitalization. After discharge, 7 patients continued with LMWH, and 18 received DOAC. Of the 26 patients, 17 (65%) showed recanalization after receiving LMWH (4) and DOAC (13) therapy after discharge.

Our data on anticoagulant therapy has a better outcome in patients with acute pancreatitis related SVT. Therefore, dynamic changes of SVT should be closely monitored, and anticoagulant therapy should be rapidly initiated to prevent the further extension of thrombosis and subsequent complications. Unfortunately, major guidelines on the management of AP are silent on this aspect. Further prospective randomised studies needed to validate the data on different anticoagulant therapies