# Early Treatment With Curative Dose Low-Molecular-Weight Heparin (LMWH) Versus Plasmapheresis in Severe Acute Pancreatitis in Intensive Care: A Comparative Study

## TL;DR

This study compares low-molecular-weight heparin (LMWH) and plasmapheresis for treating severe acute pancreatitis, finding LMWH to be more effective and safer.

## Contribution

The study introduces LMWH as a potentially superior alternative to plasmapheresis for managing hypertriglyceridemia-induced severe acute pancreatitis.

## Key findings

- LMWH reduced pancreatic necrosis rate to 8% compared to 44% with plasmapheresis.
- Patients on LMWH had shorter ICU stays (6.4 days) and fewer complications (10%) than those on plasmapheresis.
- Mortality was lower in the LMWH group (2%) compared to 14% in the plasmapheresis group.

## Abstract

Background: Severe acute pancreatitis (SAP) of hyperlipidemic origin is a serious condition that may require advanced therapeutic interventions (e.g., intravenous fluids, analgesics, insulin infusion, plasmapheresis, nutritional support, and endoscopic/surgical management). While plasmapheresis is used to eliminate circulating triglycerides and inflammatory mediators, low-molecular-weight heparins (LMWH) may offer an alternative through thrombo-inflammatory modulation.

Objective: To compare the efficacy and safety of early therapeutic-dose LMWH versus plasmapheresis in the management of SAP.

Methods: This prospective, observational, single-center study included 100 patients with hypertriglyceridemia-induced SAP. Patients were divided into two groups: 50 received therapeutic-dose LMWH, and 50 underwent plasmapheresis. Primary outcomes included necrosis rate, complication frequency, ICU stay, and mortality. Adverse events related to both interventions were recorded.

Results: LMWH was associated with a lower rate of pancreatic necrosis (8% vs. 44%, p=0.0003), fewer overall complications (10% vs. 60%, p=0.0001), and a shorter ICU stay (6.4 vs. 12.7 days, p<0.001). Mortality was lower in the LMWH group (2% vs. 14%, p=0.03). Procedure-related adverse events were less frequent with LMWH than with plasmapheresis.

Conclusion: In this single-center observational study, therapeutic-dose LMWH was associated with improved clinical outcomes and fewer adverse events compared to plasmapheresis. These findings suggest LMWH may be a safe and effective option for managing hypertriglyceridemia-induced SAP, though randomized controlled trials are needed to confirm these results.