Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: is it necessary?
OBJECTIVE
To assess the safety and effectiveness of prophylaxis for venous thromboembolism (VTE) in a large population of patients with hepatocellular carcinoma (HCC) on cirrhosis.


METHODS
Two hundred and twenty nine consecutive cirrhotic patients with HCC who underwent hepatic resection were retrospectively evaluated to assess whether there was any difference in the incidence of thrombotic or hemorrhagic complications between those who received and those who did not receive prophylaxis with low-molecular weight heparin. Differences and possible effects of the following parameters were investigated: age, sex, Child-Pugh and model for end-stage liver disease (MELD) score, platelet count, presence of esophageal varices, type of hepatic resection, duration of surgery, intraoperative transfusion of blood and fresh frozen plasma (FFP), body mass index, diabetes and previous cardiovascular disease.


RESULTS
One hundred and fifty seven of 229 (68.5%) patients received antithromboembolic prophylaxis (group A) while the remaining 72 (31.5%) patients did not (group B). Patients in group B had higher Child-Pugh and MELD scores, lower platelet counts, a higher prevalence of esophageal varices and higher requirements for intraoperative transfusion of FFP. The incidence of VTE and postoperative hemorrhage was 0.63% and 3.18% in group A and 1.38% and 1.38% in group B, respectively; these differences were not significant. None of the variables analyzed including prophylaxis proved to be risk factors for VTE, and only the presence of esophageal varices was associated with an increased risk of bleeding.


CONCLUSIONS
Prophylaxis is safe in cirrhotic patients without esophageal varices; the real need for prophylaxis should be better assessed.
Vivarelli
Marco
M
Department of Surgery and Transplantation, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy. marco.vivarelli@aosp.bo.it
Zanello
Matteo
M
Zanfi
Chiara
C
Cucchetti
Alessandro
A
Ravaioli
Matteo
M
Del Gaudio
Massimo
M
Cescon
Matteo
M
Lauro
Augusto
A
Montanari
Eva
E
Grazi
Gian Luca
GL
Pinna
Antonio Daniele
AD
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight