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Type: Journal article
Title: Anticoagulation policy after venous resection with a pancreatectomy: a systematic review
Author: Chandrasegaram, M.
Eslick, G.
Lee, W.
Brooke-Smith, M.
Padbury, R.
Worthley, C.
Chen, J.
Windsor, J.
Citation: Hepato Pancreato Biliary, 2014; 16(8):691-698
Publisher: Wiley-Blackwell
Issue Date: 2014
ISSN: 1365-182X
Statement of
Manju D. Chandrasegaram, Guy D. Eslick, Wayne Lee, Mark E Brooke-Smith, Rob Padbury, Christopher S Worthley, John W Chen, & John A Windsor
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). CONCLUSION: 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.
Keywords: Portal Vein
Description: This paper was presented at the Annual Scientific Congress of the Royal Australasian College of Surgeons (RACS), in May 2013, in Auckland, New Zealand and the RACS Tri-state Western Australia, South Australia and Northern Territory Annual Scientific Meeting 2013.
Rights: © 2013 International Hepato-Pancreato-Biliary Association
DOI: 10.1111/hpb.12205
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