Anticoagulation policy after venous resection with a pancreatectomy: a systematic review
Date
2014
Authors
Chandrasegaram, M.
Eslick, G.
Lee, W.
Brooke-Smith, M.
Padbury, R.
Worthley, C.
Chen, J.
Windsor, J.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
HPB, 2014; 16(8):691-698
Statement of Responsibility
Manju D. Chandrasegaram, Guy D. Eslick, Wayne Lee, Mark E Brooke-Smith, Rob Padbury, Christopher S Worthley, John W Chen, & John A Windsor
Conference Name
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.
School/Discipline
Dissertation Note
Provenance
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.
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Rights
© 2013 International Hepato-Pancreato-Biliary Association