Low molecular weight heparin decreases mortality and major complication rates in moderately severe and severe acute pancreatitis-a systematic review and meta-analysis

Cristina Patoni; Stefania Bunduc; Levente Frim; Dániel Sándor Veres; Fanni Dembrovszky; Anna Júlia Éliás; Dániel Pálinkás; Péter Hegyi; Bálint Mihály Erőss; Péter Jenő Hegyi

doi:10.3389/fmed.2023.1241301

Low molecular weight heparin decreases mortality and major complication rates in moderately severe and severe acute pancreatitis-a systematic review and meta-analysis

Front Med (Lausanne). 2023 Oct 25:10:1241301. doi: 10.3389/fmed.2023.1241301. eCollection 2023.

Authors

Cristina Patoni^{1

2

3}, Stefania Bunduc^{1

2

4}, Levente Frim⁵, Dániel Sándor Veres^{1

6}, Fanni Dembrovszky^{1

5}, Anna Júlia Éliás^{1

7}, Dániel Pálinkás^{1

8}, Péter Hegyi^{1

5

9

10}, Bálint Mihály Erőss^{1

5

9}, Péter Jenő Hegyi^{1

9}

Affiliations

¹ Center for Translational Medicine, Semmelweis University, Budapest, Hungary.
² Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
³ Central Military Emergency Hospital Dr. Carol Davila, Bucharest, Romania.
⁴ Fundeni Clinical Institute, Bucharest, Romania.
⁵ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁶ Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
⁷ Doctoral School of Health Sciences, Semmelweis University, Budapest, Hungary.
⁸ Department of Gastroenterology, University of Military Hospital-State Health Centre, Budapest, Hungary.
⁹ Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
¹⁰ János Szentágothai Research Center, University of Pécs, Pécs, Hungary.

Abstract

Background: Routine anticoagulation therapy in acute pancreatitis (AP) is not recommended by the guidelines in the field, although it is frequently used in clinical practice.

Objectives: We aimed to analyze the efficacy and safety of adding anticoagulants therapy to AP management.

Methods: The systematic search was performed in three databases on the 14th of October 2022 without restrictions. Randomized controlled trials (RCTs) and observational studies that reported the differences in the outcomes of AP for patients receiving anticoagulants (intervention group) in addition to the standard of care (SOC), compared to patients managed by SOC alone (control group), were eligible. A random-effects model was used to calculate the pooled odds ratios (OR) and mean differences (MD) with the corresponding 95%-confidence intervals (CI). We performed subgroup analysis for study design and disease severity, among other criteria.

Results: Of the 8,223 screened records, we included eight in the meta-analysis. Except one, all studies reported on low-molecular-weight heparin (LMWH). Both RCTs and observational studies reported results in favor of the LMWH group. Subgroup RCTs' analysis revealed significantly decreased odds of mortality [OR 0.24; 95%CI 0.17-0.34] and multiple organ failure [OR 0.32; 95%CI 0.17-0.62] in the intervention group. Moreover, the need for endoscopic or surgical interventions [OR 0.41; 95%CI 0.28-0.61] were significantly reduced by LMWH. The subgroup analyzes for moderate and severe cases, respectively, yielded similar results. Due to limited data, we could no perform subgroup analysis for mild cases.

Conclusion: LMWH therapy reduces major complication rates in moderate and severe AP. Across all identified RCTs, LMWH were initiated early after AP diagnosis and improved its prognosis.

Keywords: acute pancreatitis; anticoagulants; guideline; low-molecular-weight-heparin; meta-analysis.

Publication types

Systematic Review

Grants and funding

This project was supported by an ITM NRDIF grant (TKP2021-EGA-23). Funders had no role in the design, data collection, analysis, interpretation, manuscript preparations or decision to submit the manuscript for publication.