TOPLINE:

In adults with hypertriglyceridemic acute pancreatitis (HTG-AP), low-molecular-weight heparin (LMWH) combined with insulin was not superior to insulin therapy alone in reducing new-onset organ failure or mortality.

METHODOLOGY:

• HTG-AP manifests with severe complications, and although insulin is widely used, there is limited high-quality evidence to guide early triglyceride-lowering strategies.
• Between September 2019 and April 2023, researchers conducted an open-label superiority trial across 13 tertiary hospitals in China to test whether combining LMWH with insulin improved clinical outcomes compared with insulin alone in patients with HTG-AP.
• Eligible patients were 18-85 years old, had acute pancreatitis with serum triglyceride levels between 1000 and 3550 mg/dL, and were admitted within 48 hours of symptom onset.
• Patients were randomly assigned to receive either subcutaneous LMWH (enoxaparin 4000 IU every 12 hours for 3 days) plus insulin or insulin alone, alongside standard care.
• The primary endpoint was a composite of new-onset organ failure and/or all-cause mortality within 30 days. Secondary endpoints included time to triglyceride levels < 500 mg/dL, occurrence of complications, need for interventions, and safety outcomes such as new-onset bleeding and rebound elevation in serum triglyceride levels.

TAKEAWAY:

• Among 533 patients (median age, 39 years; 76.2% male), 264 received LMWH plus insulin and 269 received insulin alone.
• The composite primary endpoint occurred in 25.0% of the LMWH-plus-insulin group and 28.3% of the insulin-only group, with no significant difference.
• Both groups achieved triglyceride levels < 500 mg/dL within a median of 2 days, with no significant difference between them.
• There were no significant differences in new-onset bleeding, drug-related adverse events, infectious complications, need for organ support, length of hospital stay, or total hospital costs between groups.
• Triglyceride levels rose again more often in the insulin-only group, although the difference was not statistically significant (P = .05).

IN PRACTICE:

“These findings indicate that LMWH might not be necessary for early lipid-lowering in HTG-AP,” the authors of the study wrote.

SOURCE:

The study was led by Wenhua He, MD, the First Affiliated Hospital of Nanchang University, Nanchang, China. It was published online in JAMA Network Open.

LIMITATIONS:

The open-label design may have introduced observer bias. Excluding patients with triglyceride levels > 3550 mg/dL limited generalizability to more severe cases. Inflammation markers, lipoprotein lipase activity, gene mutations, and circulating free fatty acid levels were not systematically assessed.

DISCLOSURES:

The study was supported by the Double-Thousand Plan of Jiangxi Province, the Key Research and Development Program of Jiangxi Province, the Jiangxi Clinical Research Center for Gastroenterology, and the Science and Technology Innovation Team Cultivation Project. One author reported receiving personal fees from Nutricia China and Nestlé, and another receiving grants, nonfinancial support, and personal fees from various healthcare, research, and investment organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.