P4339 - The Incidence of Peripheral and Splanchnic Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis

Vikram Ram. Rajagopalan, MBBS¹, Sanjana Putta, MBBS¹, Ujwala Pamidimukkala, MD¹, Azizullah Beran, MD¹, Mina Batarseh, MD¹, Hussein Baydoun, MD¹, Awais Ahmed, MD¹, Nasir Saleem, MD¹, Daryl Ramai, MD, MPH, MSc², Indira Bhavsar-Burke, MD³, Mohannad Yousef, MD⁴, Mohammad Al-Haddad, MD¹, Itegbemie Obaitan, MD, MPH¹
1Indiana University School of Medicine, Indianapolis, IN; 2Brigham and Women's Hospital, Boston, MA; 3University of Texas Southwestern School of Medicine, Dallas, TX; 4Michigan State University/Hurley Medical Center, Flint, MI

Introduction: Venous thromboembolism (VTE) is a well-established sequela of acute pancreatitis (AP). No prior meta-analysis, however, has comprehensively explored the short-term incidence of peripheral and splanchnic VTE in patients with acute necrotizing pancreatitis (ANP).

Methods: We performed a comprehensive literature search through May 23, 2025, to identify all studies reporting the incidence of extremity DVT (eDVT), pulmonary embolism (PE), and various splanchnic (mesenteric, splenic and portal) venous thrombosis in adult patients with ANP. Two independent reviewers (VR and SP) screened articles and extracted relevant variables from each study. Statistical analysis was performed by AB using Comprehensive Meta-Analysis (Biostat, CO, USA). The random-effects model and DerSimonian Laird method were used to calculate the pooled incidence and 95% confidence intervals (CI). The Higgins I² index was used to assess heterogeneity, with I² > 50% indicating significant heterogeneity.

Results: Four studies reporting the incidence of eDVT/PE in 1,217 ANP patients, and thirteen studies reporting the incidence of SVT in 2,562 ANP patients during the in-hospital and early post-discharge period (up to 3 months post-discharge) were included in this study. The pooled incidence of eDVT was 14.5% (95% CI- 0.071-0.274, I² = 94.266%, Figure 1a) and the pooled incidence of PE was 6.1% (95% CI- 0.047-0.079, I² = 14.742%, Figure 1b). The pooled incidence of SVT was 36.2% (95% CI 0.272-0.462, I² = 94.9%, Figure 2a), with a subset of six studies with 1434 ANP patients reporting specific data on mesenteric vein, splenic vein, and portal vein thrombosis. The pooled incidence for these was 10.5% (95% CI 0.067-0.162, I² = 82.4%, Figure 2b), 20.6% (95% CI 0.115-0.343, I² = 95.2%, Figure 2c), and 12.4% (95% CI 0.092-0.165, I² = 67.9%, Figure 2d), respectively. Factors potentially contributing to the significant heterogeneity were explored.

Discussion: Current guidelines do not explicitly recommend prophylactic anticoagulation for admitted patients with ANP. However, given the high incidence of ANP-associated VTE in our study with persistent increased risk up to 3 months after discharge, further prospective large-scale studies with similar findings may start a discussion on the benefit/risk profile of in-hospital and/or post-discharge anticoagulation in this patient population, as in other pro-inflammatory conditions such as active inflammatory bowel disease (IBD).


Figure: Figure 1: Forest plots of the incidence of eDVT and PE.


Figure: Figure 2: Forest plots of the incidence of SVT as well as mesenteric, splenic, and portal vein thrombosis.

Disclosures:
Vikram Rajagopalan indicated no relevant financial relationships.
Sanjana Putta indicated no relevant financial relationships.
Ujwala Pamidimukkala indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Mina Batarseh indicated no relevant financial relationships.
Hussein Baydoun indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Nasir Saleem indicated no relevant financial relationships.
Daryl Ramai indicated no relevant financial relationships.
Indira Bhavsar-Burke indicated no relevant financial relationships.
Mohannad Yousef indicated no relevant financial relationships.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Boston Scientific – Consultant. Interpace diagnostics – Consultant.
Itegbemie Obaitan indicated no relevant financial relationships.

Vikram Ram. Rajagopalan, MBBS¹, Sanjana Putta, MBBS¹, Ujwala Pamidimukkala, MD¹, Azizullah Beran, MD¹, Mina Batarseh, MD¹, Hussein Baydoun, MD¹, Awais Ahmed, MD¹, Nasir Saleem, MD¹, Daryl Ramai, MD, MPH, MSc², Indira Bhavsar-Burke, MD³, Mohannad Yousef, MD⁴, Mohammad Al-Haddad, MD¹, Itegbemie Obaitan, MD, MPH¹. P4339 - The Incidence of Peripheral and Splanchnic Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.