title: Anticoagulation policy after venous resection with a pancreatectomy: a systematic review.
abstract: BACKGROUND
  Portal vein (PV) resection is used increasingly in pancreatic resections. There is no agreed policy regarding anticoagulation.
  
  
  METHODS
  A systematic review was performed to compare studies with an anticoagulation policy (AC+) to no anticoagulation policy (AC-) after venous resection.
  
  
  RESULTS
  There were eight AC+ studies (n = 266) and five AC- studies (n = 95). The AC+ studies included aspirin, clopidogrel, heparin or warfarin. Only 50% of patients in the AC+ group received anticoagulation. There were more prosthetic grafts in the AC+ group (30 versus 2, Fisher's exact P < 0.001). The overall morbidity and mortality was similar in both groups. Early PV thrombosis (EPVT) was similar in the AC+ group and the AC- group (7%, versus 3%, Fisher's exact P = 0.270) and was associated with a high mortality (8/20, 40%). When prosthetic grafts were excluded there was no difference in the incidence of EPVT between both groups (1% vs 2%, Fisher's exact test P = 0.621).
  
  
  CONCLUSIONS
  There is significant heterogeneity in the use of anticoagulation after PV resection. Overall morbidity, mortality and EPVT in both groups were similar. EPVT has a high associated mortality. While we have been unable to demonstrate a benefit for anticoagulation, the incidence of EPVT is low in the absence of prosthetic grafts.
authors.affiliation: HPB Department, Flinders Medical Centre, Adelaide, SA, Australia; Department of Surgery, The University of Sydney, Sydney Medical School, Nepean, Penrith, NSW, Australia.
authors.forename: Manju D
authors.initials: MD
authors.lastname: Chandrasegaram
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.forename: Wayne
authors.initials: W
authors.lastname: Lee
authors.forename: Mark E
authors.initials: ME
authors.lastname: Brooke-Smith
authors.forename: Rob
authors.initials: R
authors.lastname: Padbury
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Worthley
authors.forename: John W
authors.initials: JW
authors.lastname: Chen
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D011169:Portal Vein / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control
chemical_list: D000925:Anticoagulants