PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

Anticoagulants Decrease Mortality and Major Complication Rates in Moderately Severe and Severe Acute Pancreatitis – a Systematic Review and Meta-analysis

Text of the abstract

Introduction
Recent studies have suggested that adding anticoagulants (AC) in severe acute pancreatitis (AP) treatment improves prognosis. The proposed mechanism is the inhibition of cytokines and inflammatory mediators release.
Aims
We aimed to investigate the safety and efficacy of anticoagulation addition in the management of acute pancreatitis across all severity stages.
Method
A systematic search was performed on PubMed, Embase, and Cochrane from inception until 15th October 2021, without restrictions. Eligible studies reported on differences in clinical outcomes in AP patients with vs. without anticoagulation therapy (intervention vs. control group). We included both randomized controlled trials (RCT) and observational studies. The random-effects model estimated pooled odds ratios (OR) and mean differences (MD) with 95% confidence interval. The study protocol is registered on PROSPERO, CRD42021283239.
Results
Out of 8552 articles, we included seven in the meta-analysis and nine in the systematic review. Analyses of the RCTs revealed that: mortality is significantly decreased in the anticoagulation group (236 patients) by comparison with the control group (237 patients) [OR 0.24; 95% CI 0.13; 0.45; I2 = 0%]. Moreover, AC treatment was associated with a significantly lower rate of multiple organ failure in the intervention group (219 patients) vs. control (213 patients) [OR 0.33, 95% CI 0.18; 0.63; I2=0%]. Also need for endoscopic/surgical interventions for the management of AP was lower in the intervention group (236 patients) vs. control group (237 patients) [OR 0.41, 95% CI 0,19; 0.90; I2=0%]. Length of hospital stay was shorter in the anticoagulation group (6012 patients) vs. control (6013 patients) [MD -5,48 days, 95% CI -9,87; -1.10; I2=98%]. The analysis included both RCTs and observational studies. Two studies evaluated the risk of bleeding which had a lower incidence in the intervention group.
Conclusion
Based on our results, anticoagulants are safe and reduce the complication rates in moderately severe and severe AP cases. We suggest starting anticoagulation therapy at AP diagnosis since it is associated with an improved prognosis. Further trials are needed to assess the safety of AC in mild AP and evaluate the risk of bleeding.