Insulin and LMWH have demonstrated therapeutic promise in the treatment of hypertriglyceridemic acute pancreatitis (HTG-AP). By increasing lipoprotein lipase activity, lowering inflammation, and boosting microcirculation, this regimen speeds up the removal of triglycerides. When compared to traditional supportive care alone, studies indicate it may reduce recovery time and minimize problems. Thus, this study determined if LMWH with insulin improves clinical outcomes in hypertriglyceridemic acute pancreatitis better than insulin alone.
13 Chinese tertiary hospitals participated in this clinical study from September 21, 2019, to April 2, 2023. Following randomization, the follow-up period lasted for 30 days. Patients between the ages of 18 and 85 who were hospitalized within 48 hours of the beginning of symptoms, had baseline blood triglyceride levels between 1000 and 3550 mg/dL, and satisfied the diagnostic criteria for acute pancreatitis were eligible.
Subcutaneous LMWH with insulin (LMWH plus insulin group) or insulin alone (insulin group) were administered to participants. A composite of all-cause death within 30 days following randomization and/or new-onset organ failure (defined as organ failure occurring after randomization but absent during the 24-hour prerandomization period) served as the main end point.
264 of the 533 randomized patients (median [IQR] age, 39 [33-46] years; 406 [76.2%] male) received LMWH + insulin, whereas 269 received insulin alone. 66 (25.0%) of the LMWH and insulin group and 76 (28.3%) of the insulin group experienced the primary end point (relative risk [RR], 0.89; 95% CI, 0.67-1.17; P =.40). In a median (IQR) of 2 (1-3) days, both groups reached the triglyceride objective (<500 mg/dL) (P =.94).
Triglyceride rebound (RR, 0.53; 95% CI, 0.28-1.01; P =.05), new-onset bleeding episodes (RR, 0.61; 95% CI, 0.15-2.53; P =.73), and drug-related adverse events (RR, 0.79; 95% CI, 0.30-2.10; P =.64). Overall, when compared to insulin monotherapy, individuals with HTG-AP who received LMWH in addition to insulin treatment showed no additional clinical benefit in this randomized clinical study. These results suggest that early lipid-lowering in HTG-AP may not require LMWH.
Source:
He, W., Ding, L., Liu, Z., Hua, M., Zhou, Y., Gong, M., Sheng, J., Wu, X., Fan, H., Shu, H., Wang, R., Xun, L., Huang, C., Guo, F., Cao, C., Zhan, Z., Chen, H., Qian, X., Liu, Q., … Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG). (2025). Low-molecular-weight heparin plus insulin in hypertriglyceridemic acute pancreatitis: A randomized clinical trial: A randomized clinical trial. JAMA Network Open, 8(11), e2542124. https://doi.org/10.1001/jamanetworkopen.2025.42124
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