title: Venous thromboembolic prophylaxis after a hepatic resection: patterns of care among liver surgeons.
abstract: BACKGROUND
  No consensus exists for post-hepatectomy venous thromboembolic (VTE) prophylaxis. Factors impacting VTE prophylaxis patterns among hepato-pancreato-biliary (HPB) surgeons were defined.
  
  
  METHODS
  Surgeons were invited to complete a web-based survey on VTE prophylaxis. The impact of physician and clinical factors was analysed.
  
  
  RESULTS
  Two hundred responses were received. Most respondents were male (91%) and practiced at academic centres (88%) in the United States (80%). Surgical training varied: HPB (24%), transplantation (24%), surgical oncology (34%), HPB/transplantation (13%), or no specialty (5%). Respondents estimated VTE risk was higher after major (6%) versus minor (3%) resections. Although 98% use VTE prophylaxis, there was considerable variability: sequential compression devices (SCD) (91%), unfractionated heparin Q12h (31%) and Q8h (32%), and low-molecular weight heparin (39%). While 88% noted VTE prophylaxis was not impacted by operative indication, 16% stated major resections reduced their VTE prophylaxis. Factors associated with the decreased use of pharmacologic prophylaxis included: elevated international normalized ratio (INR) (74%), thrombocytopaenia (63%), liver insufficiency (58%), large EBL (46%) and complications (8%). Forty-seven per cent of respondents wait until ≥post-operative day 1 (POD1) and 35% hold pharmacologic VTE prophylaxis until no signs of coagulopathy. A minority (14%) discharge patients on pharmacologic prophylaxis. While 81% have institutional VTE guidelines, 79% believe hepatectomy-specific guidelines would be helpful.
  
  
  CONCLUSIONS
  There is considerable variation regarding VTE prophylaxis among liver surgeons. While most HPB surgeons employ VTE prophylaxis, the methods, timing and purported contraindications differ significantly.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D032921:Consensus; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006470:Hemorrhage / Q000139:chemically induced; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D020407:Internet; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents