Preoperative dosing of low-molecular-weight heparin in hepatopancreatobiliary surgery.

Abstract:

BACKGROUND:Venous thromboembolism is a common cause of morbidity. Guidelines recommend perioperative thromboprophylaxis, but clinicians remain cautious of bleeding after major oncologic resections. METHODS:Retrospective analysis of a single institution's prospective hepatopancreatobiliary database was performed for patients undergoing surgery between January 2010 and February 2013. A total of 223 patients received postoperative thromboprophylaxis and 93 patients were dosed with low-molecular-weight heparin (LMWH) preoperatively. RESULTS:Two hundred twenty-three patients were analyzed; 50.6% underwent pancreatic and 49.3% underwent liver resection. There were no differences in previous venous thromboembolism (3.8% vs 3.3%; P = .56) or preoperative venous thromboembolism scores (5.74 vs 5.67; P = .82). Estimated blood loss (537 mL vs 592 mL; P = .54), transfusions (25.4% vs 30.4%; P = .25), and complications (52.3% vs 43.5%; P = .12) were equivalent. Incidence of thromboembolic events was lower (6.1% vs 1.1%; P = .05); however, bleeding requiring intervention was increased in the preoperative LMWH group (10.9% vs 3.1%; P = .026). CONCLUSIONS:Caution must be exercised when using LMWH, as bleeding remains a concern for oncologic hepatopancreatobiliary surgery.

journal_name

Am J Surg

authors

Doughtie CA,Priddy EE,Philips P,Martin RC,McMasters KM,Scoggins CR

doi

10.1016/j.amjsurg.2014.08.012

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

1009-15; discussion 1015

issue

6

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(14)00445-0

journal_volume

208

pub_type

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