title: Post-operative pharmacologic thromboprophylaxis after major hepatectomy: does peripheral venous thromboembolism prevention outweigh bleeding risks?
abstract: BACKGROUND
  Although standard of care after most abdominal surgeries, post-operative pharmacologic thromboprophylaxis after major hepatectomy is commonly withheld due to bleeding risks. The objective of this retrospective study is to evaluate the benefits and risks of post-operative pharmacologic thromboprophylaxis after major hepatectomy at two high volume academic centers.
  
  
  METHODS
  Demographics, clinicopathologic data, treatments, and post-operative outcomes from patients who underwent major hepatectomy were reviewed.
  
  
  RESULTS
  From 2005 to 2010, 419 patients underwent major hepatectomy; 275 (65.6%) were treated with pharmacologicthromboprophylaxis beginning a median of 1 day after resection. Post-operative symptomatic venous thromboembolism (VTE) occurred in 15 (3.6%) patients. Patients treated with pharmacologic thromboprophylaxis had lower rates of symptomatic VTE (2.2% vs. 6.3%, p = 0.03) and post-operative red blood cell (RBC) transfusion (16.7% vs. 26.4%, p = 0.02) with similar rates of overall RBC transfusion (35.0% vs. 30.6%, p = 0.36) compared to untreated patients. Specifically, isolated deep venous thrombosis (0% vs. 2.1%, p = 0.04) and pulmonary embolism (2.2% vs. 4.2%, p = 0.35) occurred less often in treated patients. Analysis of demographics, clinicopathologic data, and treatment factors revealed that pharmacologic thromboprophylaxis was the only variable associated with post-operative VTE.
  
  
  CONCLUSIONS
  Post-operative pharmacologic thromboprophylaxis lowers the incidence of symptomatic VTE after major hepatectomy without increasing the rate of RBC transfusion.
authors.affiliation: University of Pittsburgh Medical Center, Liver Cancer Center, UPMC Montefiore 7 South, Pittsburgh, PA 15213, USA. reddysk@upmc.edu
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight