Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy

Reddy, Srinevas K.; Turley, Ryan S.; Barbas, Andrew S.; Steel, Jennifer L.; Tsung, Allan; Marsh, J. Wallis; Clary, Bryan M.; Geller, David A.

doi:10.1007/s11605-011-1591-x

Cited by 57 publications

(25 citation statements)

References 55 publications

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“…1,26–29 Mita et al 30 reported a higher rate of postoperative bleeding after gastric cancer surgery among patients receiving chemoprophylaxis (8.1 %) compared with no chemoprophylaxis (0.7 %). In contrast, Reddy et al 14 reported that VTE chemoprophylaxis did not increase the rate of red blood cell transfusion after major hepatectomy. In the current study, while we noted a slight increase in the incidence of post-operative and overall transfusion among patients receiving chemoprophylaxis, no patient required reoperation secondary to bleeding.…”

Section: Discussionmentioning

confidence: 89%

“…13 While Reddy et al examined VTE after hepatectomy using institutional data, the study involved multiple centers with different utilization patterns of VTE prophylaxis. 14 It is interesting to note that heterogeneity with regard to VTE prophylaxis similarly existed at our own single center. Because of this variability, in 2008 a multidisciplinary team at our institution established a specialty-specific, mandatory, computerized clinical decision support module for VTE risk stratification and prevention.…”

Section: Discussionmentioning

confidence: 95%

“…In contrast, other studies have noted that chemoprophylaxis was indeed associated with a lower incidence of VTE after hepatectomy. 14 …”

Section: Discussionmentioning

confidence: 99%

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Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Ejaz

Spolverato

Kim

et al. 2014

Journal of Gastrointestinal Surgery

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Background The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE. Methods Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses. Results A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n =402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVTand PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81–17.22, P =0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04–1.32, P =0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02–1.12, P =0.01) were independent risk factors for VTE. Conclusion VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS, are warranted.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 95%

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Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Ejaz

Spolverato

Kim

et al. 2014

Journal of Gastrointestinal Surgery

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“…A transfusion is associated with the risks of infection, fluid overload, anaphylaxis and transfusion‐related acute lung injury (TRALI) . Thromboprophylaxis is considered the standard of care after major abdominal operations owing to the associated risk of a deep vein thrombosis (DVT) and pulmonary embolism (PE) and it is frequently delayed because of an elevated PT‐INR . While reported rates of venous thromboembolism (VTE) vary in the literature, data exist suggesting that withholding thromboprophylaxis leads to a higher rate of clinically significant VTE.…”

Section: Introductionmentioning

confidence: 99%

Coagulopathy after a liver resection: is it over diagnosed and over treated?

Barton

Riha

Differding

et al. 2013

HPB

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“…Pharmacologic thromboprophylaxis is recommended for most general surgery procedures, but the fear of bleeding after major hepatectomy has limited its use. [ 14 ] However, recent evidences show that hepatectomy patients are in fact hyper-coagulable. Many factors including tissue damage, reduced synthesis of clotting factors by the remnant liver and blood loss are considered the reason for the hyper-coagulability.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of post-operative coagulopathy after major hepatic resection at a tertiary care centre in Northern India

et al. 2017

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Background and Aims:Hepatic resection is a major surgery associated with intraoperative massive fluid shifts, blood loss, haemodynamic instability and risk of development of post-hepatectomy liver failure. Hepatic resection predisposes the patient to coagulopathy as well as venous thrombosis. However, due to the development of deranged coagulation profile post-operatively, there is a dilemma in starting thromboprophylaxis. Our aim in this study was to determine the incidence of coagulopathy in patients undergoing major hepatectomy.Methods:In this retrospective study, we included 86 patients who had undergone major hepatectomy between January 2010 and December 2015 at our centre. Intraoperatively, we noted the number of liver segments resected, details of epidural catheter insertion, estimated blood loss, transfusion requirement and need for mechanical ventilation post-operatively. Trends of international normalised ratio (INR) and platelet values were recorded until post-operative day 5.Results:Of the 86 patients, 6 (7%) had an abnormal coagulation profile pre-operatively and 39 (45.34%) patients developed a derangement in their coagulation profile on 1st post-operative day (POD). Platelet count was significantly lower and INR values were significantly higher than the pre-operative values on all 5 PODs. Sixty-seven (78%) patients had pre-operative epidural catheter insertion for post-operative pain management. Mechanical thrombophylaxis was used routinely.Conclusions:The incidence of post-operative coagulopathy in our patients who underwent major liver resection was 45.34%. Epidural catheters could be removed safely without transfusion between POD 5 and 7. There was no incidence of venous thrombosis or thromboembolism.

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Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy

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

Cited by 57 publications

References 55 publications

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Coagulopathy after a liver resection: is it over diagnosed and over treated?

Retrospective analysis of post-operative coagulopathy after major hepatic resection at a tertiary care centre in Northern India

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