Low-molecular-weight heparin and respiratory failure in hypertriglyceridemia-associated acute pancreatitis

The role of low-molecular-weight heparin (LMWH) in preventing respiratory failure among patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP) remains uncertain. We aimed to examine the association between LMWH use and respiratory failure in HTG-AP.

This post-hoc analysis was based on a multicenter, prospective cohort. Adult patients with HTG-AP (plasma triglycerides >11.3 mmol/L) admitted within 72 h of onset between February 2020 and July 2023 were included. Patients receiving LMWH during the first week were classified as the LMWH group, and those without LMWH served as controls. The primary outcome was defined as new-onset respiratory failure within 14 days of enrollment. Multivariate logistic regression and inverse probability of treatment weighting (IPTW) were applied to adjust for confounders.

A total of 387 patients (287 [74.2%] male; median [IQR] age, 37 [32-44] years) were enrolled, including 326 in the LMWH group and 61 controls. Of the LMWH group, 260 (79.8%) received LMWH at baseline, and most (295 [90.5%]) received LMWH for >2 days. LMWH use was associated with a reduced risk of respiratory failure (including baseline and post-enrollment cases) (adjusted OR 0.42, 95% CI 0.23-0.76; P = 0.004) and specifically new-onset respiratory failure (i.e., developed after enrollment, adjusted OR 0.46, 95% CI 0.23-0.94; P = 0.033). Longer time from onset to enrollment, higher total bilirubin, and higher APACHE II score were also predictors of respiratory failure. IPTW analysis confirmed these findings.

LMWH use may be associated with a lower incidence of respiratory failure in HTG-AP. These findings warrant confirmation in a randomized controlled trial.