Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective

Abstract

Background The incidence of venous thromboembolism remains high after liver surgery. Objective To evaluate the safety and efficacy of extended pharmacologic thromboprophylaxis in liver surgery for the prevention of venous thromboembolism (VTE). Patient/Methods From August 2013 to April 2015, 124 patients who underwent liver resection for malignancy were placed on an extended pharmacologic thromboprophylaxis protocol. Intraoperative VTE prophylaxis included Thrombo-Embolic Deterrent hose and sequential compression devices. Once hemostasis was assured following hepatectomy, daily anticoagulant VTE prophylaxis was initiated for the hospitalization. After hospital discharge, the large majority of patients (114, 91.9%) continued anticoagulant thromboprophylaxis (enoxaparin) to complete a total course of 14 days after minor/minimally invasive (MIS) hepatectomy or 28 days after major hepatectomy or a history of VTE. Results The cohort included 39 (31.2%) major hepatectomies and 38 (31.5%) MIS approaches. The intraoperative, postoperative and overall transfusion rates were 5.6%, 8.1% and 10.5% respectively. Pharmacologic thromboprophylaxis was started on postoperative day (POD) 0 for 40 (32.3%) patients and POD 1 for 84 (67.7%) patients. During 90-days of follow-up, no postoperative symptomatic DVT or pulmonary embolic events were diagnosed. Standard protocol computed tomography scans of the chest/abdomen/pelvis that were obtained on 112 (90.3%) study patients identified no pulmonary emboli, other thoracic, splanchnic, or ileofemoral vein thromboses. Two (1.6%) patients had minor bleeding events that resolved after discontinuation of enoxaparin, requiring neither blood transfusion nor reoperation. The severe complication rate was 5.6%, with no 90-day mortalities. Conclusions These preliminary data suggest that extended pharmacologic thromboprophylaxis for liver surgery patients is safe and effective.

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

“…Other lower-quality studies have provided similar results in urologic oncology surgery, 79 after radical cystectomy for bladder cancer surgery, 80,81 and in liver resection for cancer. 82 In lung cancer surgery, the results of the cohort study by Hachey et al 83 suggested that the application of a revised Caprini risk assessment model could be helpful to select patients who would benefit from extended prophylaxis.…”

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

“…16,17 Furthermore, there is mounting evidence supporting its use after bariatric, liver and pancreas surgeries. 18,19 Therefore, it is imperative that consensus guidelines are continually revised to reflect the latest research developments.…”

“…This is despite recent meta‐analyses demonstrating its safety and efficacy after abdominopelvic surgery for malignant and benign diseases 16,17 . Furthermore, there is mounting evidence supporting its use after bariatric, liver and pancreas surgeries 18,19 . Therefore, it is imperative that consensus guidelines are continually revised to reflect the latest research developments.…”

Pulmonary Embolism in a Donor of Living Donor Liver Transplantation

“…However, because of the risk of posttransplant hemorrhage and the lack of evidence of anticoagulant prophylaxis in liver surgery, prophylactic anticoagulant therapy following donation is not routinely performed. Nevertheless, several studies have recently reported the safety and efficacy of pharmacological thromboprophylaxis in liver surgery [13, 14]. A recent study on the risk stratification approaches for VTE prophylaxis based on thrombophilia test results in a large cohort of LDLT donors revealed its necessity and usefulness [15].…”