Journal of Gastrointestinal Surgery

, Volume 15, Issue 9, pp 1602–1610

Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy

Does Peripheral Venous Thromboembolism Prevention Outweigh Bleeding Risks?
  • Srinevas K. Reddy
  • Ryan S. Turley
  • Andrew S. Barbas
  • Jennifer L. Steel
  • Allan Tsung
  • J. Wallis Marsh
  • Bryan M. Clary
  • David A. Geller
Original Article

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 

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Srinevas K. Reddy
    • 1
  • Ryan S. Turley
    • 2
  • Andrew S. Barbas
    • 2
  • Jennifer L. Steel
    • 1
  • Allan Tsung
    • 1
  • J. Wallis Marsh
    • 1
  • Bryan M. Clary
    • 2
  • David A. Geller
    • 1
  1. 1.University of Pittsburgh Medical Center, Liver Cancer CenterPittsburghUSA
  2. 2.Duke University Medical CenterDurhamUSA

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