Link between heparin therapy duration and mortality in acute pancreatitis

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Created On: 06/09/2025

This retrospective study sought to explore the relationship between the duration of heparin (anticoagulant) therapy and mortality in patients with acute pancreatitis.

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Key take away

Heparin therapy shorter than 4 days increases 30- and 90-day mortality, while a 7-day duration exhibits the lowest mortality in critically ill patients suffering from acute pancreatitis.

Background

This retrospective study sought to explore the relationship between the duration of heparin (anticoagulant) therapy and mortality in patients with acute pancreatitis.

Method

This study utilized data from 2 large critical care databases: [1] the Medical Information Mart for Intensive Care IV (MIMIC-IV), and [2] the eICU Collaborative Research Database (eICU-CRD). A total of 1,705 patients diagnosed with acute pancreatitis from 2008 to 2019 were incorporated. For assessing the potential non-linear connections between the duration of heparin use and both 30-day and 90-day mortality, the restricted cubic spline (RCS) modeling was applied.

Volunteers were segregated into 4 groups based on quartile distribution and RCS curve characteristics: <4 days, 4–7 days, 8–14 days, and >14 days, with the 4–7 day group serving as the reference. Cox proportional hazards regression and Kaplan–Meier survival analyses were carried out for determining the mortality outcomes, with 30-day mortality as the key endpoint and 90-day mortality as the secondary endpoint.

Result

A J-shaped association was noted between heparin use duration and mortality at both 30 and 90 days. The lowest mortality rates were witnessed around 7 days of treatment. Contrarily, those receiving heparin for fewer than 4 days exhibited markedly higher risks of death at 30 days (hazard ratio [HR]: 2.57, 95% confidence interval [CI]: 1.53–4.30) and 90 days (HR: 1.57, 95% CI: 1.07–2.32). Mortality rates appeared to plateau beyond the 7-day mark. Subgroup analyses based on disease severity consistently supported these patterns.

Conclusion

Among critically ill patients battling acute pancreatitis, short-duration heparin therapy (<4 days) was linked to increased short- and medium-term mortality. The most favorable survival outcomes were linked with heparin therapy lasting approximately 7 days.