Background <p>Intra-abdominal hypertension (IAH) is a common complication in patients with acute pancreatitis (AP) and can lead to multiple organ failure. The efficacy of anticoagulant therapy for IAH in patients with acute pancreatitis is unclear. The objective of this study aimed to investigate the effects of anticoagulant therapy on IAH in patients with acute pancreatitis.</p> Materials and methods <p>A total of 49 AP patients with IAH were included in this retrospective study, with 34 patients in the anticoagulant group and 15 patients in the non-anticoagulant group. The effects of anticoagulant therapy on intra-abdominal pressure, inflammation markers, disease severity, and imaging indices were compared between the two groups.</p> Results <p>The anticoagulant group had significantly lower intra-abdominal pressure at 60&#xa0;h of therapy compared to the non-anticoagulant group. In addition, inflammation markers and modified Marshall score were significantly improved in the anticoagulant group after 7 days of therapy. There was no significant difference in imaging indices, length of stay and mortality in hospital between the two groups. No adverse bleeding events or allergic reactions occurred during the treatment period. No significant difference was found in the rate of splanchnic vein thrombosis and portal hypertension between the two groups six months after the onset of the disease.</p> Conclusion <p>Anticoagulant therapy may be a potential treatment option for IAH in patients with acute pancreatitis.</p>