Venous thromboembolism prophylaxis after hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Tao ,  YAN Lünan , LUO Yanli

Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding author：

YAN Lünan, Email: yanlunan688@163.com

Keywords：

hepatectomy; venous thromboembolism; prophylaxis

DOI：

10.7507/1007-9424.201612074

Video：

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Objective To investigate the risk factors and prevention methods of the venous thromboembolism (VTE) after hepatectomy. Methods The literatures about VTE after hepatectomy in recent years at home and abroad were reviewed and summarized. Results The risk factors for postoperative VTE include tumor, male, old age, massive hepatectomy, hypercoagulability, etc. The incidence of VTE in patients with massive hepatectomy is significantly higher, which is closely related to the hypercoagulability caused by postoperative liver dysfunction. Effective prophylaxis include mechanical methods and anticoagulant drugs, the latter of which can markedly reduce the incidence of VTE. For patients who develop postoperative liver insufficiency, including those with cirrhosis and high risk of bleeding, anticoagulant VTE prophylaxis dosing decisions should be made with caution. In addition, it is rationale for extended thromboprophylaxis in high risk patients. Conclusions VTE is a common complication after hepatectomy, resulting in prolonged postoperative hospital stay and increased postoperative mortality. Therefore, it is important to determine the risk of VTE after surgery to improve the prognosis of patients after hepatectomy.

Citation： WU Tao, YAN Lünan, LUO Yanli. Venous thromboembolism prophylaxis after hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 895-899. doi: 10.7507/1007-9424.201612074 Copy

1.	De Martino RR, Goodney PP, Spangler EL, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
2.	Reddy SK, Turley RS, Barbas AS, et al. Post-operative pharmacologic thromboprophylaxis after major hepatectomy: does peripheral venous thromboembolism prevention outweigh bleeding risks? J Gastrointest Surg, 2011, 15(9): 1602-1610.
3.	Nathan H, Weiss MJ, Soff GA, et al. Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg, 2014, 18(2): 295-302.
4.	Tzeng CW, Katz MH, Fleming JB, et al. Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications: analysis of 5 651 National Surgical Quality Improvement Program patients. HPB (Oxford), 2012, 14(8): 506-513.
5.	Russell MC. Complications following hepatectomy. Surg Oncol Clin N Am, 2015, 24(1): 73-96.
6.	Tzeng CW, Curley SA, Vauthey JN, et al. Distinct predictors of pre- versus post-discharge venous thromboembolism after hepatectomy: analysis of 7 621 NSQIP patients. HPB (Oxford), 2013, 15(10): 773-780.
7.	Turley RS, Reddy SK, Shortell CK, et al. Venous thromboembolism after hepatic resection: analysis of 5 706 patients. J GastrointestSurg, 2012, 16(9): 1705-1714.
8.	Ejaz A, Spolverato G, Kim Y, et al. Defining incidence and risk factors of venous thromboemolismafterhepatectomy. J Gastrointest Surg, 2014, 18(6): 1116-1124.
9.	Bellini G, Teng A, Kotecha N, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res, 2016, 205(2): 279-285.
10.	Aloia TA, Fahy BN, Fischer CP, et al. Predicting poor outcome following hepatectomy: analysis of 2 313 hepatectomies in the NSQIP database. HPB (Oxford), 2009, 11(6): 510-515.
11.	Tsai J, Grant AM, Beckman MG, et al. Determinants of venous thromboembolism among hospitalizations of US adults: a multilevel analysis. PLoS One, 2015, 10(4): e0123842.
12.	Ahern TP, Horváth-Puhó E, Spindler KL, et al. Colorectal cancer, comorbidity, and risk of venous thromboembolism: assessment of biological interactions in a Danish nationwide cohort. Br J Cancer, 2016, 114(1): 96-102.
13.	Singh VA, Yong LM, Vijayananthan A. Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study. Springerplus, 2016, 5(1): 943.
14.	Geahchan N, Basile M, Tohmeh M, et al. Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry. Springerplus, 2016, 5(1): 1541.
15.	Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
16.	Ye S, Zhang W, Yang J, et al. Pattern of venous thromboembolism occurrence in gynecologic malignancy: incidence, timing, and distribution a 10-year retrospective single-institutional study. Medicine (Baltimore), 2015, 94(50): e2316.
17.	Newhook TE, LaPar DJ, Walters DM, et al. Impact of postoperative venous thromboembolism on postoperative morbidity, mortality, and resource utilization after hepatectomy. Am Surg, 2015, 81(12): 1216-1223.
18.	Hayashi H, Morikawa T, Yoshida H. Safety of postoperative thromboprophylaxis after major hepatobiliary-pancreatic surgery in Japanese patients. Surg Today, 2014, 44(9): 1660-1668.
19.	Qureshi W, Ali Z, Amjad W, et al. Venous thromboembolism in cancer: an update of treatment and prevention in the era of newer anticoagulants. Front Cardiovasc Med, 2016, 3: 24.
20.	Kim JH, Min SK, Lee H. The safety and risk factors of major hepatobiliary pancreatic surgery in patients older than 80 years. Ann Surg Treat Res, 2016, 91(6): 288-294.
21.	Cerutti E, Stratta C, Romagnoli R, et al. Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation. Liver Transpl, 2004, 10(2): 289-294.
22.	Abdelaziz O, Hosny K, Elmalt O, et al. Intra-operative ultrasound-guided thrombectomy and thrombolysis for post-operative portal vein thrombosis in living liver donors. Int J Organ Transplant Med, 2015, 6(1): 33-40.
23.	孟海鹏, 雷建勇, 杨家印, 等. 活体肝移植供体安全性的研究 (单中心 356 例临床分析).中国普外基础与临床杂志, 2015, 22(12): 1428-1433.
24.	周良艺, 陈燕凌. 肝脏手术后肺动脉栓塞的危险因素分析和防治体会. 福建医药杂志, 2015, 37(3): 24-26.
25.	Reddy SK, Barbas AS, Turley RS, et al. A standard definition of major hepatectomy: resection of four or more liver segments. HPB (Oxford), 2011,13(7): 494-502.
26.	De Pietri L, Montalti R, Begliomini B, et al. Thromboelastographic changes in liver and pancreatic cancer surgery: hypercoagulability, hypocoagulability or normocoagulability? Eur J Anaesthesiol, 2010, 27(7): 608-616.
27.	Farid SG, Prasad KR, Morris-Stiff G. Operative terminology and post-operative management approaches applied to hepatic surgery: trainee perspectives. World J Gastrointest Surg, 2013, 5(5): 146-155.
28.	Dondero F, Farges O, Belghiti J, et al. A prospective analysis of living-liver donation shows a high rate of adverse events, J Hepatobil Pancreat Surg, 2006, 13(2): 117-122.
29.	Candido HL, da Fonseca EA, Feier FH, et al. Risk factors associated with increased morbidity in living liver donation. J Transplant, 2015, 2015: 949674.
30.	Rocino A, Franchini M, Coppola A. Treatment and prevention of bleeds in haemophilia patients with inhibitors to factor Ⅷ/Ⅸ. J Clin Med, 2017, 6(4). pii: E46.
31.	Kim HJ, Kim CY, Hur YH, et al. Comparison of remnant to total functional liver volume ratio and remnant to standard liver volume ratio as a predictor of postoperative liver function after liver resection. Korean J HepatobiliaryPancreat Surg, 2013, 17(4): 143-151.
32.	Peck-Radosavljevic M, Angeli P, Cordoba J, et al. Managing complications in cirrhotic patients. United European Gastroenterol J, 2015, 3(1): 80-94.
33.	Koliscak L, Maynor L. Pharmacologic prophylaxis against venous thromboembolism in hospitalized patients with cirrhosis and associated coagulopathies. Am J Health Syst Pharm, 2012, 69(8): 658-663.
34.	Aggarwal A, Puri K, Liangpunsakul S. Deep vein thrombosis and pulmonary embolism in cirrhotic patients: systematic review. World J Gastroenterol, 2014, 20(19): 5737-5745.
35.	Lizarraga WA, Dalia S, Reinert SE, et al. Venous thrombosis in patients with chronic liver disease. Blood CoagulFibrinol, 2010, 21(5): 431-435.
36.	Siu J, McCall J, Connor S. Systematic review of pathophysiological changes following hepatic resection. HPB (Oxford), 2014, 16(5): 407-421.
37.	Aloia TA, Geerts WH, Clary BM, et al. Venous thromboembolism prophylaxis in liver surgery. J Gastrointest Surg, 2016, 20(1): 221-229.
38.	Orbach-Zinger S, Eidelman LA, Lutsker A. The effect of in vitro fertilization on coagulation parameters as measured by thromboelastogram. Eur J Obstet Gynecol Reprod Biol, 2016, 201: 118-120.
39.	Gosselin RC, Estacio EE, Song JY, et al. Verifying the performance characteristics of the TEG5000 thromboelastogram in the clinical laboratory. Int J Lab Hematol, 2016, 38(2): 183-192.
40.	Barton JS, Riha GM, Differding JA, et al. Coagulopathy after a liver resection: is it over diagnosed and over treated? HPB (Oxford), 2013, 15(11): 865-871.
41.	Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbsto prevent venous thromboembolism in hospitalized patients. Circulation, 2013, 128(9): 1003-1020.
42.	Palacios FS, Rathbun SW. Medical treatment for postthrombotic syndrome. Semin Intervent Radiol, 2017, 34(1): 61-67.
43.	Akl EA, Labedi N, Terrenato I, et al. Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer. Cochrane Database Syst Rev, 2014, 6: CD009447.
44.	Hyder O, Pulitano C, Firoozmand A, et al. A risk model to predict 90-day mortality among patients undergoing hepatic resection. J Am Coll Surg, 2013, 216(6): 1049-1056.
45.	杨盛柯, 李川, 米凯, 等. 活体肝移植供体及有或无肝硬变肝病患者右半肝切除术后预后的比较分析. 中国普外基础与临床杂志, 2013, 20(7): 756-761.
46.	Mita K, Ito H, Murabayashi R, et al. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol, 2012, 19(12): 3745-3752.
47.	Vivarelli M, Zanello M, Zanfi C, et al. Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: is it necessary? World J Gastroenterol, 2010, 16(17): 2146-2150.
48.	Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol, 2016, 17(10): e452-e466.
49.	Weiss MJ, Kim Y, Ejaz A, et al. Venous thromboembolic prophylaxis after a hepatic resection: patterns of care among liver surgeons. HPB (Oxford), 2014, 16(10): 892-898.
50.	Encke A, Haas S, Kopp I. The prophylaxis of venous thromboembolism. Dtsch Arztebl Int, 2016, 113(31-32): 532-538.

1. De Martino RR, Goodney PP, Spangler EL, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
2. Reddy SK, Turley RS, Barbas AS, et al. Post-operative pharmacologic thromboprophylaxis after major hepatectomy: does peripheral venous thromboembolism prevention outweigh bleeding risks? J Gastrointest Surg, 2011, 15(9): 1602-1610.
3. Nathan H, Weiss MJ, Soff GA, et al. Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg, 2014, 18(2): 295-302.
4. Tzeng CW, Katz MH, Fleming JB, et al. Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications: analysis of 5 651 National Surgical Quality Improvement Program patients. HPB (Oxford), 2012, 14(8): 506-513.
5. Russell MC. Complications following hepatectomy. Surg Oncol Clin N Am, 2015, 24(1): 73-96.
6. Tzeng CW, Curley SA, Vauthey JN, et al. Distinct predictors of pre- versus post-discharge venous thromboembolism after hepatectomy: analysis of 7 621 NSQIP patients. HPB (Oxford), 2013, 15(10): 773-780.
7. Turley RS, Reddy SK, Shortell CK, et al. Venous thromboembolism after hepatic resection: analysis of 5 706 patients. J GastrointestSurg, 2012, 16(9): 1705-1714.
8. Ejaz A, Spolverato G, Kim Y, et al. Defining incidence and risk factors of venous thromboemolismafterhepatectomy. J Gastrointest Surg, 2014, 18(6): 1116-1124.
9. Bellini G, Teng A, Kotecha N, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res, 2016, 205(2): 279-285.
10. Aloia TA, Fahy BN, Fischer CP, et al. Predicting poor outcome following hepatectomy: analysis of 2 313 hepatectomies in the NSQIP database. HPB (Oxford), 2009, 11(6): 510-515.
11. Tsai J, Grant AM, Beckman MG, et al. Determinants of venous thromboembolism among hospitalizations of US adults: a multilevel analysis. PLoS One, 2015, 10(4): e0123842.
12. Ahern TP, Horváth-Puhó E, Spindler KL, et al. Colorectal cancer, comorbidity, and risk of venous thromboembolism: assessment of biological interactions in a Danish nationwide cohort. Br J Cancer, 2016, 114(1): 96-102.
13. Singh VA, Yong LM, Vijayananthan A. Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study. Springerplus, 2016, 5(1): 943.
14. Geahchan N, Basile M, Tohmeh M, et al. Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry. Springerplus, 2016, 5(1): 1541.
15. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
16. Ye S, Zhang W, Yang J, et al. Pattern of venous thromboembolism occurrence in gynecologic malignancy: incidence, timing, and distribution a 10-year retrospective single-institutional study. Medicine (Baltimore), 2015, 94(50): e2316.
17. Newhook TE, LaPar DJ, Walters DM, et al. Impact of postoperative venous thromboembolism on postoperative morbidity, mortality, and resource utilization after hepatectomy. Am Surg, 2015, 81(12): 1216-1223.
18. Hayashi H, Morikawa T, Yoshida H. Safety of postoperative thromboprophylaxis after major hepatobiliary-pancreatic surgery in Japanese patients. Surg Today, 2014, 44(9): 1660-1668.
19. Qureshi W, Ali Z, Amjad W, et al. Venous thromboembolism in cancer: an update of treatment and prevention in the era of newer anticoagulants. Front Cardiovasc Med, 2016, 3: 24.
20. Kim JH, Min SK, Lee H. The safety and risk factors of major hepatobiliary pancreatic surgery in patients older than 80 years. Ann Surg Treat Res, 2016, 91(6): 288-294.
21. Cerutti E, Stratta C, Romagnoli R, et al. Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation. Liver Transpl, 2004, 10(2): 289-294.
22. Abdelaziz O, Hosny K, Elmalt O, et al. Intra-operative ultrasound-guided thrombectomy and thrombolysis for post-operative portal vein thrombosis in living liver donors. Int J Organ Transplant Med, 2015, 6(1): 33-40.
23. 孟海鹏, 雷建勇, 杨家印, 等. 活体肝移植供体安全性的研究 (单中心 356 例临床分析).中国普外基础与临床杂志, 2015, 22(12): 1428-1433.
24. 周良艺, 陈燕凌. 肝脏手术后肺动脉栓塞的危险因素分析和防治体会. 福建医药杂志, 2015, 37(3): 24-26.
25. Reddy SK, Barbas AS, Turley RS, et al. A standard definition of major hepatectomy: resection of four or more liver segments. HPB (Oxford), 2011,13(7): 494-502.
26. De Pietri L, Montalti R, Begliomini B, et al. Thromboelastographic changes in liver and pancreatic cancer surgery: hypercoagulability, hypocoagulability or normocoagulability? Eur J Anaesthesiol, 2010, 27(7): 608-616.
27. Farid SG, Prasad KR, Morris-Stiff G. Operative terminology and post-operative management approaches applied to hepatic surgery: trainee perspectives. World J Gastrointest Surg, 2013, 5(5): 146-155.
28. Dondero F, Farges O, Belghiti J, et al. A prospective analysis of living-liver donation shows a high rate of adverse events, J Hepatobil Pancreat Surg, 2006, 13(2): 117-122.
29. Candido HL, da Fonseca EA, Feier FH, et al. Risk factors associated with increased morbidity in living liver donation. J Transplant, 2015, 2015: 949674.
30. Rocino A, Franchini M, Coppola A. Treatment and prevention of bleeds in haemophilia patients with inhibitors to factor Ⅷ/Ⅸ. J Clin Med, 2017, 6(4). pii: E46.
31. Kim HJ, Kim CY, Hur YH, et al. Comparison of remnant to total functional liver volume ratio and remnant to standard liver volume ratio as a predictor of postoperative liver function after liver resection. Korean J HepatobiliaryPancreat Surg, 2013, 17(4): 143-151.
32. Peck-Radosavljevic M, Angeli P, Cordoba J, et al. Managing complications in cirrhotic patients. United European Gastroenterol J, 2015, 3(1): 80-94.
33. Koliscak L, Maynor L. Pharmacologic prophylaxis against venous thromboembolism in hospitalized patients with cirrhosis and associated coagulopathies. Am J Health Syst Pharm, 2012, 69(8): 658-663.
34. Aggarwal A, Puri K, Liangpunsakul S. Deep vein thrombosis and pulmonary embolism in cirrhotic patients: systematic review. World J Gastroenterol, 2014, 20(19): 5737-5745.
35. Lizarraga WA, Dalia S, Reinert SE, et al. Venous thrombosis in patients with chronic liver disease. Blood CoagulFibrinol, 2010, 21(5): 431-435.
36. Siu J, McCall J, Connor S. Systematic review of pathophysiological changes following hepatic resection. HPB (Oxford), 2014, 16(5): 407-421.
37. Aloia TA, Geerts WH, Clary BM, et al. Venous thromboembolism prophylaxis in liver surgery. J Gastrointest Surg, 2016, 20(1): 221-229.
38. Orbach-Zinger S, Eidelman LA, Lutsker A. The effect of in vitro fertilization on coagulation parameters as measured by thromboelastogram. Eur J Obstet Gynecol Reprod Biol, 2016, 201: 118-120.
39. Gosselin RC, Estacio EE, Song JY, et al. Verifying the performance characteristics of the TEG5000 thromboelastogram in the clinical laboratory. Int J Lab Hematol, 2016, 38(2): 183-192.
40. Barton JS, Riha GM, Differding JA, et al. Coagulopathy after a liver resection: is it over diagnosed and over treated? HPB (Oxford), 2013, 15(11): 865-871.
41. Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbsto prevent venous thromboembolism in hospitalized patients. Circulation, 2013, 128(9): 1003-1020.
42. Palacios FS, Rathbun SW. Medical treatment for postthrombotic syndrome. Semin Intervent Radiol, 2017, 34(1): 61-67.
43. Akl EA, Labedi N, Terrenato I, et al. Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer. Cochrane Database Syst Rev, 2014, 6: CD009447.
44. Hyder O, Pulitano C, Firoozmand A, et al. A risk model to predict 90-day mortality among patients undergoing hepatic resection. J Am Coll Surg, 2013, 216(6): 1049-1056.
45. 杨盛柯, 李川, 米凯, 等. 活体肝移植供体及有或无肝硬变肝病患者右半肝切除术后预后的比较分析. 中国普外基础与临床杂志, 2013, 20(7): 756-761.
46. Mita K, Ito H, Murabayashi R, et al. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol, 2012, 19(12): 3745-3752.
47. Vivarelli M, Zanello M, Zanfi C, et al. Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: is it necessary? World J Gastroenterol, 2010, 16(17): 2146-2150.
48. Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol, 2016, 17(10): e452-e466.
49. Weiss MJ, Kim Y, Ejaz A, et al. Venous thromboembolic prophylaxis after a hepatic resection: patterns of care among liver surgeons. HPB (Oxford), 2014, 16(10): 892-898.
50. Encke A, Haas S, Kopp I. The prophylaxis of venous thromboembolism. Dtsch Arztebl Int, 2016, 113(31-32): 532-538.

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