Venous Thromboembolism Prophylaxis in Liver Surgery

Aloia, Thomas A.; Geerts, William; Clary, Bryan M.; Day, Ryan; Hemming, Alan W.; D’Albuquerque, Luiz Carneiro; Vollmer, Charles M.; Vauthey, Jean Nicolas; Toogood, Giles J.

doi:10.1007/s11605-015-2902-4

Cited by 35 publications

(26 citation statements)

References 46 publications

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“…Although our institution has reported a low rate of bleeding complications , it is important to note that, nationally, 33% of liver resection patients are transfused . For this reason, the published guideline for VTE prophylaxis in patients undergoing liver surgery indicates that preoperative dosing is optional . Currently, in our practice, a preoperative dose is given when the indicated operation is a minor hepatectomy or a major hepatectomy with a low a priori risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective

Kim

Day

Davis

et al. 2017

Journal of Thrombosis and Haemostasis

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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.

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Section: Discussionmentioning

confidence: 99%

Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective

Kim

Day

Davis

et al. 2017

Journal of Thrombosis and Haemostasis

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“…A recent Clinical Guidelines Symposium at the America's Hepato-Pancreato-Biliary Association (AHPBA) Annual Meeting on VTE in Liver Surgery concluded that postoperative chemical thromboprophylaxis should be initiated immediately after hepatectomy in hemodynamically stable patients without evidence of bleeding. 6 The aim of this study is to conduct a systematic review of the available data addressing the role of chemical thromboprophylaxis for patients undergoing liver resection. The principal focus of this study is to assess whether perioperative chemical thromboprophylaxis decreases the incidence of VTE without compromising safety and without causing an increase in bleeding complications.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of pharmacological venous thromboembolism prophylaxis following liver resection: a systematic review and meta-analysis

Baltatzis

Low

Stathakis

et al. 2017

HPB

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“…In other case series, the incidence of venous thromboembolism has been reported to be as high as 1 in 20 patients in the first 90 days postoperatively [16]. Liver resection patients that experience venous thromboembolism have prolonged hospital stay and increased mortality, up to 7.4% compared with those patients that do not have thrombosis [17,18]. There is also an association between the magnitude of the hepatectomy and the incidence of venous thrombosis.…”

Section: Liver Surgerymentioning

confidence: 94%

Anaemia and cardiac surgery

Feneck

2016

Anaesthesia

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Venous Thromboembolism Prophylaxis in Liver Surgery

Abstract: This conference was effective in consolidating our knowledge of coagulation abnormalities after liver resection. Based on the expert review of the available data and practice patterns, a number of recommendations were developed.

Cited by 35 publications

References 46 publications

Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective

Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective

Efficacy and safety of pharmacological venous thromboembolism prophylaxis following liver resection: a systematic review and meta-analysis

Anaemia and cardiac surgery

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