Evaluation of the Safety and Efficacy of Postoperative Thromboprophylaxis After Hepatobiliary-Pancreatic Surgery

Abstract

Although chemical thromboprophylaxis after abdominal surgery is recommended for preventing postoperative venous thromboembolism (VTE), the use of such drugs after major hepatobiliary-pancreatic surgery is typically avoided due to the increased risk of hemorrhage. We analyzed the rates of postoperative bleeding events, VTE and morbidity to evaluate the safety and efficacy of chemical thromboprophylaxis in 466 patients who underwent major hepatobiliary-pancreatic surgery. Four thousand international units per day of enoxiaparin were administered for 90 patients, 2.5 mg/day and 1.5 mg/day of fondaparinux was administered for 125 and 58 patients, respectively. The remaining 193 patients did not receive any chemical prophylaxis. Chemical thromboprophylaxis was associated with a significantly increased rate and risk of overall bleeding events as compared to patients who did not receive chemical thromboprophylaxis. Most of the postoperative hemorrhage was minor and chemical prophylaxis did not increase the risk of major hemorrhage requiring blood transfusion or hemostatic intervention. The rate of VTE was decreased in the patients with chemical prophylaxis. We consider that chemical thromboprophylaxis is beneficial and can be safely used even after major hepatobiliary-pancreatic surgery.