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.
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.
Authors: Giancarlo Agnelli; Giorgio Bolis; Lorenzo Capussotti; Roberto Mario Scarpa; Francesco Tonelli; Erminio Bonizzoni; Marco Moia; Fabio Parazzini; Romina Rossi; Francesco Sonaglia; Bettina Valarani; Carlo Bianchini; Gualberto Gussoni Journal: Ann Surg Date: 2006-01 Impact factor: 12.969
Authors: C M Samama; P Albaladejo; D Benhamou; M Bertin-Maghit; N Bruder; J D Doublet; S Laversin; S Leclerc; E Marret; P Mismetti; E Samain; A Steib Journal: Eur J Anaesthesiol Date: 2006-02 Impact factor: 4.330
Authors: Patrick G Northup; Matthew M McMahon; A Parker Ruhl; Scott E Altschuler; Agata Volk-Bednarz; Stephen H Caldwell; Carl L Berg Journal: Am J Gastroenterol Date: 2006-07 Impact factor: 10.864
Authors: Dieter C Broering; Christian Wilms; Pamela Bok; Lutz Fischer; Lars Mueller; Christian Hillert; Christian Lenk; Jong-Sun Kim; Martina Sterneck; Karl-Heinz Schulz; Gerrit Krupski; Axel Nierhaus; Detlef Ameis; Martin Burdelski; Xavier Rogiers Journal: Ann Surg Date: 2004-12 Impact factor: 12.969
Authors: Rebecca A Schroeder; Carlos E Marroquin; Barbara Phillips Bute; Shukri Khuri; William G Henderson; Paul C Kuo Journal: Ann Surg Date: 2006-03 Impact factor: 12.969
Authors: Thomas A Aloia; Bridget N Fahy; Craig P Fischer; Stephen L Jones; Andrea Duchini; Joseph Galati; A Osama Gaber; R Mark Ghobrial; Barbara L Bass Journal: HPB (Oxford) Date: 2009-09 Impact factor: 3.647
Authors: Hari Nathan; Matthew J Weiss; Gerald A Soff; Michelle Stempel; Ronald P Dematteo; Peter J Allen; T Peter Kingham; Yuman Fong; William R Jarnagin; Michael I D'Angelica Journal: J Gastrointest Surg Date: 2013-10-16 Impact factor: 3.452
Authors: Thomas A Aloia; William H Geerts; Bryan M Clary; Ryan W Day; Alan W Hemming; Luiz Carneiro D'Albuquerque; Charles M Vollmer; Jean-Nicolas Vauthey; Giles J Toogood Journal: J Gastrointest Surg Date: 2016-01 Impact factor: 3.452
Authors: Emmanuel Melloul; Martin Hübner; Michael Scott; Chris Snowden; James Prentis; Cornelis H C Dejong; O James Garden; Olivier Farges; Norihiro Kokudo; Jean-Nicolas Vauthey; Pierre-Alain Clavien; Nicolas Demartines Journal: World J Surg Date: 2016-10 Impact factor: 3.352
Authors: Aslam Ejaz; Gaya Spolverato; Yuhree Kim; Donald L Lucas; Brandyn Lau; Matthew Weiss; Fabian M Johnston; Marin Kheng; Marian Kheng; Kenzo Hirose; Christopher L Wolfgang; Elliott Haut; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2013-12-13 Impact factor: 3.452
Authors: Jeffrey S Barton; Gordon M Riha; Jerome A Differding; Samantha J Underwood; Jodie L Curren; Brett C Sheppard; Rodney F Pommier; Susan L Orloff; Martin A Schreiber; Kevin G Billingsley Journal: HPB (Oxford) Date: 2013-01-29 Impact factor: 3.647