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Safety and efficacy of postoperative pharmacologic thromboprophylaxis with enoxaparin after pancreatic surgery

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Abstract

Purpose

Pharmacologic thromboprophylaxis is recommended for preventing pulmonary embolism according to some abdominal surgery guidelines. However, few reports have so far described pharmacologic thromboprophylaxis after pancreatic surgery. In addition, concern remains regarding postoperative bleeding due to pharmacologic thromboprophylaxis. We investigated the safety and efficacy of enoxaparin, a low-molecular-weight heparin, as postoperative pharmacologic thromboprophylaxis after pancreatic surgery.

Methods

In this record-based retrospective study, the sample population comprised 151 consecutive patients who underwent pancreatic surgery and received enoxaparin postsurgery at our institute between November 2009 and March 2014. The primary outcome was the incidence of symptomatic pulmonary embolism after surgery, and the secondary outcome was the incidence of bleeding as an adverse effect of enoxaparin injection.

Results

No symptomatic pulmonary embolism events occurred during the study. Major and minor bleeding events were experienced in 5 (3.3%) cases each. Four of these major events were caused by the rupture of a pseudoaneurysm with a pancreatic fistula not related to enoxaparin, and all events were treated safely with no mortalities in the study period. We found no factors related to minor bleeding with enoxaparin injection in a statistical comparison.

Conclusion

The use of enoxaparin is considered to be safe and effective for pulmonary embolism prophylaxis after pancreatic surgery.

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Abbreviations

ACCP guidelines:

American College of Chest Physicians guidelines

DVT:

Deep vein thrombosis

IVR:

Interventional radiology

PE:

Pulmonary embolism

POD:

Postoperative day

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hajime Imamura, Tomohiko Adachi, Amane Kitasato, Takayuki Tanaka, Akihiko Soyama, Masaaki Hidaka, Fumihiko Fujita, Mitsuhisa Takatsuki, Tamotsu Kuroki & Susumu Eguchi

Authors
  1. Hajime Imamura
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  2. Tomohiko Adachi
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  3. Amane Kitasato
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  4. Takayuki Tanaka
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  5. Akihiko Soyama
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  6. Masaaki Hidaka
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  7. Fumihiko Fujita
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  8. Mitsuhisa Takatsuki
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  9. Tamotsu Kuroki
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  10. Susumu Eguchi
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Corresponding author

Correspondence to Susumu Eguchi.

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Conflict of interest

Hajime Imamura and the co-authors declare no conflicts of interest.

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Imamura, H., Adachi, T., Kitasato, A. et al. Safety and efficacy of postoperative pharmacologic thromboprophylaxis with enoxaparin after pancreatic surgery. Surg Today 47, 994–1000 (2017). https://doi.org/10.1007/s00595-017-1471-4

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  • DOI: https://doi.org/10.1007/s00595-017-1471-4

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