Original Article

Journal of Gastrointestinal Surgery

, Volume 15, Issue 9, pp 1602-1610

First online:

Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy

Does Peripheral Venous Thromboembolism Prevention Outweigh Bleeding Risks?
  • 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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Abstract

Background

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.

Methods

Demographics, clinicopathologic data, treatments, and post-operative outcomes from patients who underwent major hepatectomy were reviewed.

Results

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.

Conclusions

Post-operative pharmacologic thromboprophylaxis lowers the incidence of symptomatic VTE after major hepatectomy without increasing the rate of RBC transfusion.

Keywords

Liver resection Venous thromboembolism Thromboprophylaxis