Written by Kevin Liu
Spoon Feed
For hypertriglyceridemia-induced pancreatitis, any combination of plasmapheresis, heparin, and insulin showed no additional benefit, so supportive care remains the gold standard
2.5 strikes for heroic hypertriglyceridemia-induced pancreatitis treatments
Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) often prompts aggressive interventions, with plasmapheresis, heparin, and insulin becoming the recommended treatments for normoglycemic patients. Unfortunately, while observational studies have suggested these therapies could rapidly lower triglyceride levels and decrease illness, this systematic review and meta-analysis of 24 studies found no significant differences in mortality, length of stay, ICU admission, or clinical outcomes when comparing these interventions to standard supportive care.
How does this change my practice?
The article also points out the elephant in the room; namely, that we don’t have a high-powered RCT, and there is heterogeneity in intervention protocols and definitions. While we wait for that research to be developed and published, I’ll be shifting my focus back towards early fluids, pain control, and treating underlying metabolic risk factors like diabetes and alcohol use.
Source
Futility of plasmapheresis, insulin in normoglycaemic individuals, or heparin in the treatment of hypertriglyceridaemia-induced acute pancreatitis. Lancet Diabetes Endocrinol. 2025 Jun;13(6):528-536. doi: 10.1016/S2213-8587(25)00028-2. Epub 2025 Mar 24. PMID: 40147461
