Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy
- Srinevas K. ReddyAffiliated withUniversity of Pittsburgh Medical Center, Liver Cancer Center Email author
- , Ryan S. TurleyAffiliated withDuke University Medical Center
- , Andrew S. BarbasAffiliated withDuke University Medical Center
- , Jennifer L. SteelAffiliated withUniversity of Pittsburgh Medical Center, Liver Cancer Center
- , Allan TsungAffiliated withUniversity of Pittsburgh Medical Center, Liver Cancer Center
- , J. Wallis MarshAffiliated withUniversity of Pittsburgh Medical Center, Liver Cancer Center
- , Bryan M. ClaryAffiliated withDuke University Medical Center
- , David A. GellerAffiliated withUniversity of Pittsburgh Medical Center, Liver Cancer Center
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Although standard of care after most abdominal surgeries, post-operative pharmacologic thromboprophylaxis after major hepatectomy is commonly withheld due to bleeding risks. The objective of this retrospective study is to evaluate the benefits and risks of post-operative pharmacologic thromboprophylaxis after major hepatectomy at two high volume academic centers.
Demographics, clinicopathologic data, treatments, and post-operative outcomes from patients who underwent major hepatectomy were reviewed.
From 2005 to 2010, 419 patients underwent major hepatectomy; 275 (65.6%) were treated with pharmacologicthromboprophylaxis beginning a median of 1 day after resection. Post-operative symptomatic venous thromboembolism (VTE) occurred in 15 (3.6%) patients. Patients treated with pharmacologic thromboprophylaxis had lower rates of symptomatic VTE (2.2% vs. 6.3%, p = 0.03) and post-operative red blood cell (RBC) transfusion (16.7% vs. 26.4%, p = 0.02) with similar rates of overall RBC transfusion (35.0% vs. 30.6%, p = 0.36) compared to untreated patients. Specifically, isolated deep venous thrombosis (0% vs. 2.1%, p = 0.04) and pulmonary embolism (2.2% vs. 4.2%, p = 0.35) occurred less often in treated patients. Analysis of demographics, clinicopathologic data, and treatment factors revealed that pharmacologic thromboprophylaxis was the only variable associated with post-operative VTE.
Post-operative pharmacologic thromboprophylaxis lowers the incidence of symptomatic VTE after major hepatectomy without increasing the rate of RBC transfusion.
KeywordsLiver resection Venous thromboembolism Thromboprophylaxis
- Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy
Journal of Gastrointestinal Surgery
Volume 15, Issue 9 , pp 1602-1610
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- Liver resection
- Venous thromboembolism
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- Author Affiliations
- 1. University of Pittsburgh Medical Center, Liver Cancer Center, UPMC Montefiore 7 South, 3459 Fifth Avenue, Pittsburgh, PA, 15213, USA
- 2. Duke University Medical Center, 485 Seeley G. Mudd Building, Searle Center, Durham, NC, 27710, USA