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EPVST linked to inflammation, not thrombophilia in alcoholic pancreatitis
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Local inflammation increased the risk for extrahepatic portal venous system thrombosis in patients with alcoholic pancreatitis, while thrombophilia did not, in a recent study.
Researchers evaluated 119 patients (100 men) with acute (AP) or chronic (CP) alcoholic pancreatitis. CT scans of the pancreas were conducted on all patients to determine the presence of extrahepatic portal venous system thrombosis (EPVST). Testing for thrombophilia also was performed.
CP was present in 87 patients; the other 32 were diagnosed with relapsing AP. Twenty-two patients in the entire cohort had thrombophilia, of which 21 had biological antiphospholipid syndrome, two had factor V Leiden gene mutation, and one had factor II G20210A mutation. Patients with recurrent AP were more likely to have coagulation disorders than those with CP (34% of patients vs. 12%, P=.005).
EPVST was present in 41 patients and involved the portal (34%), superior mesenteric (24%) and splenic (93%) veins. Hemostatic prothrombotic risk factors were identified in seven patients; all had biological antiphospholipid syndrome, and one also had the factor V Leiden mutation.
Univariate analysis indicated associations between EPVST and smoking (P=.03), the presence of pseudocysts (P=.009), pancreatic parenchymal necrosis (P=.02), a pseudocyst located in the pancreatic tail (P=.03) and a high CT severity index among patients with AP (P=.007). Only pseudocysts remained significantly associated with EPVST following multivariate analysis (HR=6.402; 95% CI, 1.59-26.54). No significant association was found between hemostatic risk factors and increased risk for EPVST.
“The risk factors of EPVST were local factors correlated to the severity of pancreatitis,” the researchers wrote. “These results confirm that the degree of inflammation and compression by pseudocysts are probably the most important risk factors of thrombosis. … The presence of some form of thrombophilia does not increase the risk of EPVST, and should not be systematically searched for in case of EPVST.”
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