Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients: A retrospective cohort study
Wen-Jian Mao a , b , # , Jing Zhou a , b , # , Guo-Fu Zhang a , b , # , Fa-Xi Chen a , b , Jing-Zhu Zhang a , Bai-Qiang Li a , b , Lu Ke a , b , c , Wei-Qin Li a , b , c , ∗
a Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
b Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
c National Institute of Healthcare Data Science, Nanjing University, Nanjing 210010, China
∗Corresponding author at: Department of Critical Care Medicine, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China.
E-mail address: ctgchina@medbit.cn (W.-Q. Li).
# Contributed equally
Abstract：Background: Early systemic anticoagulation (SAC) is a common practice in acute necrotizing pancreatitis (ANP), and its impact on in-hospital clinical outcomes had been assessed. However, whether it affects long-term outcomes is unknown. This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.
Methods: During January 2013 and December 2018, ANP patients admitted within 7 days from the on- set of abdominal pain were screened. The primary outcome was 90-day readmission after discharge. Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.
Results: A total of 241 ANP patients were enrolled, of whom 143 received early SAC during their hospitalization and 98 did not. Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis (SVT) [risk ratio (RR) = 0.40, 95% CI: 0.26-0.60, P < 0.01] and lower 90-day read- mission with an RR of 0.61 (95% CI: 0.41-0.91, P = 0.02) than those who did not. For the quality of life, patients who received early SAC had a significantly higher score in the subscale of vitality ( P = 0.03) while the other subscales were all comparable between the two groups. Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjust- ing for potential confounders with a hazard ratio of 0.57 (95% CI: 0.34-0.96, P = 0.04). Mediation analysis showed that SVT mediated 37.0% of the early SAC-90-day readmission causality.
Conclusions: The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients, and reduced SVT incidence might be the primary contributor.
2024, Vol. 23 
