Peripheral and splanchnic venous thromboembolism in acute and infected necrotizing pancreatitis: A systematic review and meta-analysis.

BACKGROUND: Venous thromboembolism (VTE) is a well-established sequela of acute necrotizing pancreatitis (ANP). No prior meta-analysis has comprehensively explored the pooled incidence of VTE in this patient population. METHODS: We performed a comprehensive literature search from inception to July 2025, to identify all studies reporting the incidence of VTE after an index episode of ANP. Two independent reviewers screened articles and extracted relevant variables. The random-effects model was used to calculate the pooled incidence and 95% confidence intervals (CI) of thrombosis in each anatomical location. Risk of bias assessment was done via the Newcastle-Ottawa Scale. The Higgins I2 index was used to assess heterogeneity, with I2 > 50% indicating significant heterogeneity. RESULTS: 4243 patients across 24 studies were analysed. The pooled incidence of extremity DVT (eDVT) was 14% (95% CI: 4%-28%, I2 = 93.8%) across 6 studies and 4% (95% CI: 2-8%, I2 = 76.4%) for pulmonary embolism (PE) across 5. The pooled incidence for Splanchnic vein thrombosis (SVT) was 34% (95% CI: 26%-42%, I2 = 94.5%) with a higher SVT incidence of 53% (95% CI: 34%-72%, I2 = 86.1%) in the infected necrosis sub-group. The splenic vein was the commonly involved vein in the splanchnic system at 20% (95% CI: 12%-29%, I2 = 94.1%). CONCLUSION: There is a relatively high incidence of VTE in patients with pancreatic necrosis, with the incidence in some anatomical locations being of particular clinical importance. Prospective cohort studies are needed to better delineate subgroups at higher risk for thrombosis in this patient population and assess the risk/benefit of increased anticoagulation dosing.