fondaparinux and Pancreatitis

Splanchnic vein thrombosis (SVT) is a possible complication of acute pancreatitis (AP). There are no precise guidelines on the use of anticoagulant therapy (AT) in these patients. The aim of the study was to determine the safety and the efficacy of AT in AP-associated SVT. Two hundred twenty-one patients were retrospectively and consecutively enrolled from the Pancreatic Outpatient Clinic of the "A. Gemelli" hospital. Patients had a diagnosis of AP and a diagnostic imaging to evaluate whether they had or not SVT. Twenty-seven out of 221 AP patients had SVT (12.21%) and AT therapy was administered to 16 patients (59.3%), for 5.2 ± 2.2 months. A therapeutic dose of low molecular weight heparin was administered (100 UI/kg b.i.d.) at the diagnosis, with fondaparinux 7.5 mg/day, or vitamin K antagonist, or the novel direct oral anti-coagulants, upon discharge. The presence of SVT resulted significantly associated to male sex (p = 0.002). The recanalization rates were 11/16 (68.7%) in patients who received AT, and 3/11 (27.3%) in patients who did not receive it. There was a significant difference between the recanalization rates with and without AT (p = 0.03, OR 5.87). No SVT recurrence was registered during follow-up. No treated patient developed haemorrhagic complications after AT. No deaths were recorded, either in the group undergoing AT or in the one that was not. In conclusion, AT in AP-associated SVT appears to be safe and effective; yet prospective clinical trials are needed to confirm our results.

Topics: Adult; Aged; Anticoagulants; Chi-Square Distribution; Female; Fondaparinux; Humans; Italy; Male; Middle Aged; Pancreatitis; Prospective Studies; Retrospective Studies; Splanchnic Circulation; Thrombosis

To present a case of heparin induced thrombocytopenia in a patient treated with enoxaparin.. A case of heparin-induced thrombocytopenia was examinated with a detailed platelet count analysis over the time and with detection of platelets antibodies.. The detection of platelet antobodies and the recovery of platelet count after cessation of enoxaparin strongly support the diagnosis of heparin-induced thrombocytopenia (HIT).. HIT is a severe side effects of heparin administration. It is more frequent in patients treated with unfractionated heparin however can also be induced by low molecular weight heparin. Guideline suggests the cessation of heparin administration and the treatment of patients with fondaparinux.. Enoxaparin, Heparin induced thrombocytopenia, Thrombocytopenia.. Scopo dell’articolo è la presentazione di un caso di trombocitopenia indotto dall’eparina in un paziente trattato con enoxaparine. L’osservazione in questione è stata analizzata in dettaglio con ripetute conta delle piastrine e con l’individuazione di anticorpi antipiastrine. La scoperta degli anticorpi-antipiastrine ed il restauro della conta piastrinica dopo la cessazione della somministrazione dell’enoxaparina è alla base della diagnosi di trombocitopenia indotta dall’eparina. Questo tipo di trombocitopenia è un grave effetto collaterale della somministrazione di eparina, ed è più frequente nei pazienti trattati con eparina non frazionata, ma può comunque essere provocata dalla somministrazione di eparina a basso peso molecolare. Le linee guida suggeriscono di sospendere la somministrazione di eparina e di trattare i pazienti con fondaparinux.

Topics: Anticoagulants; Autoantibodies; Drug Substitution; Duodenal Neoplasms; Enoxaparin; Female; Fondaparinux; Humans; Immunoglobulin G; Intensive Care Units; Middle Aged; Pancreatitis; Polysaccharides; Postoperative Complications; Thrombocytopenia