S2459 Impact of Cirrhosis on Rare and Common Thromboembolic Events in Acute Pancreatitis: A Propensity-Matched Cohort Study

Introduction: Cirrhosis increases the risk of mortality and thromboembolic complications in acute pancreatitis (AP), particularly portal vein thrombosis (PVT) and deep vein thrombosis (DVT). While these are well-described, the incidence of rarer thromboemolic events, such as hepatic vein, inferior vena cava (IVC), and left ventricular (LV) thrombi, remains unknown. Methods: We conducted a retrospective cohort study using the TriNetX database to compare thromboembolic events in hospitalized adults with AP with and without cirrhosis. Cirrhosis was defined using validated International Classification of Diseases, Tenth Revision codes recorded prior to or at the index AP admission. Propensity score matching (1:1) was performed for demographics and comorbidities to minimize baseline differences. The primary outcomes were rare thromboembolic events, and results were reported using risk ratios (RRs) with 95% confidence intervals (CIs); statistical significance was defined as P < 0.05. Results: We identified 27,002 AP patients with cirrhosis and 586,636 without. Following 1:1 propensity score matching, rare thromboembolic events were significantly more common in cirrhotic patients: hepatic vein thrombosis (0.19% vs 0.04%; RR 5.02, 95% CI 2.55–9.90; P < 0.001) and IVC thrombosis (0.12% vs 0.06%; RR 1.83, 95% CI 1.01–3.30; P = 0.042). Left ventricular thrombus was not significantly different between groups (0.20% vs 0.19%; RR 1.02, 95% CI 0.69–1.51; P = 0.919). Among secondary outcomes, cirrhotic patients had higher risk of PVT (2.2% vs 0.5%; RR 4.03, 95% CI 3.35–4.85; P < 0.001) and DVT (1.8% vs 1.4%; RR 1.31, 95% CI 1.14–1.50; P < 0.001), while rates of pulmonary embolism (1.1% vs 1.2%; RR 0.93, 95% CI 0.79–1.09; P = 0.379), axillary (0.04% vs 0.04%; RR 1.10, 95% CI 0.47–2.59; P = 0.826), and subclavian vein thrombosis (0.05% vs 0.04%; RR 1.40, 95% CI 0.62–3.15; P = 0.414) were also not significantly different. Conclusion: Cirrhosis is associated with a significantly increased risk of rare thromboembolic events in acute pancreatitis, particularly hepatic vein and IVC thromboses. These findings highlight the need for increased clinical awareness and targeted risk stratification in this high-risk population.