Thrombotic complications in pancreatitis: diagnostics and prevention

Acute (AP) and chronic pancreatitis (CP) — one of the most important healthcare issues, the solution of which is associated with significant material costs due to the high incidence of this pathology, difficulties in diagnosis and treatment, often complicated course of the disease. In this connection, special attention should be paid to the thrombotic complication of pancreatitis, namely splanchnic venous thrombosis (SVT), development of which significantly increases the probability of adverse outcome. Currently, there are no specific recommendations for the treatment of SVT, and some issues of anticoagulant therapy are still controversial. Objective. To perform optimization of the treatment algorithm for patients with pancreatitis complicated by splanchnic venous thrombosis. Materials and methods. A systematic search in four databases, namely MedLine (through PubMed), Embase, Cochrane (CENTRAL) and Scopus was performed based on the study of scientific sources for the period from 2010 to 2025 using the following keywords: «acute pancreatitis», «chronic pancreatitis», «thrombosis of splanchnic veins», «acute thrombosis», «chronic thrombosis», «recanalization», «anticoagulant therapy». Results. The need for anticoagulant therapy in patients with AP and CP, both in acute and chronic thrombosis, has been shown during the study. In acute thrombosis, therapy should start with application of low-molecular-weight heparins, and when the international normalized ratio of 2—3 is reached, transfer to therapy with oral anticoagulants or vitamin K antagonists and treatment up to 6 months are indicated. Long-term treatment with anticoagulants is required in chronic thrombosis with persistent risk factors, and in the presence of transient risk factors long-term treatment with anticoagulants is indicated in recurrent thrombosis and episodes of intestinal ischemia. Conclusion. Presently, there are many controversial issues on the management of patients with pancreatitis complicated by splanchnic venous thrombosis, that is associated with the risk of increased bleeding frequency. The optimal algorithm for treatment of patients with this pathology has been determined based on the study of modern sources.