title: Preoperative dosing of low-molecular-weight heparin in hepatopancreatobiliary surgery.
abstract: BACKGROUND
  Venous thromboembolism is a common cause of morbidity. Guidelines recommend perioperative thromboprophylaxis, but clinicians remain cautious of bleeding after major oncologic resections.
  
  
  METHODS
  Retrospective analysis of a single institution's prospective hepatopancreatobiliary database was performed for patients undergoing surgery between January 2010 and February 2013. A total of 223 patients received postoperative thromboprophylaxis and 93 patients were dosed with low-molecular-weight heparin (LMWH) preoperatively.
  
  
  RESULTS
  Two hundred twenty-three patients were analyzed; 50.6% underwent pancreatic and 49.3% underwent liver resection. There were no differences in previous venous thromboembolism (3.8% vs 3.3%; P = .56) or preoperative venous thromboembolism scores (5.74 vs 5.67; P = .82). Estimated blood loss (537 mL vs 592 mL; P = .54), transfusions (25.4% vs 30.4%; P = .25), and complications (52.3% vs 43.5%; P = .12) were equivalent. Incidence of thromboembolic events was lower (6.1% vs 1.1%; P = .05); however, bleeding requiring intervention was increased in the preoperative LMWH group (10.9% vs 3.1%; P = .026).
  
  
  CONCLUSIONS
  Caution must be exercised when using LMWH, as bleeding remains a concern for oncologic hepatopancreatobiliary surgery.
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA.
authors.forename: Cathryn A
authors.initials: CA
authors.lastname: Doughtie
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Priddy
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA.
authors.forename: Prejesh
authors.initials: P
authors.lastname: Philips
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.affiliation: Division of Surgical Oncology, Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville, Suite 303, 315 East Broadway, Louisville, KY 40202, USA. Electronic address: charles.scoggins@nortonhealthcare.org.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D010182:Pancreatic Diseases / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Bleeding; Hepatopancreatobiliary surgery; Low-molecular-weight heparin; Oncologic resection; Perioperative prophylaxis; Venous thromboembolism