title: Safety of postoperative thromboprophylaxis after major hepatobiliary-pancreatic surgery in Japanese patients.
abstract: OBJECTIVE
  Thromboprophylaxis is recommended for preventing postoperative venous thromboembolism (VTE) after abdominal surgery; however, its use after major hepatobiliary-pancreatic surgery is typically avoided as it increases the risk of bleeding. We conducted this study to evaluate the safety of thromboprophylaxis after major hepatobiliary-pancreatic surgery.
  
  
  METHODS
  We analyzed the rates of postoperative bleeding, VTE, morbidity, and prolonged hospital stay in 349 patients who underwent major hepatobiliary-pancreatic surgery, such as pancreaticoduodenectomy, hemihepatectomy or greater, and hepatopancreaticoduodenectomy.
  
  
  RESULTS
  Chemical thromboprophylaxis was associated with significantly increased rates and risks of overall bleeding events vs. no chemical thromboprophylaxis (26.6 vs. 8.5%, respectively). The rate of minor hemorrhage was significantly higher in patients who received chemical thromboprophylaxis (21.7 vs. 3.5%); however, there were no differences in the rate of major hemorrhage requiring blood transfusion or hemostatic intervention between the groups (4.8 vs. 4.9%). The postoperative VTE rate was also significantly decreased by chemical thromboprophylaxis (2.9 vs. 7.7%). However, chemical thromboprophylaxis did not affect the rate of SSI, severe morbidity, or duration of the postoperative hospital stay.
  
  
  CONCLUSIONS
  We consider that chemical thromboprophylaxis is beneficial and can be safely used even after major hepatobiliary-pancreatic surgery.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan, hiroki@surg1.med.tohoku.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Takanori
authors.initials: T
authors.lastname: Morikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Takaho
authors.initials: T
authors.lastname: Okada
authors.forename: Kei
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Masamichi
authors.initials: M
authors.lastname: Mizuma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naitoh
authors.forename: Yu
authors.initials: Y
authors.lastname: Katayose
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D044466:Asian People; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000453:epidemiology; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016577:Pancreaticoduodenectomy; D011134:Polysaccharides / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012306:Risk; D012449:Safety; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux