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Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy.

Publication ,  Journal Article
Nathan, H; Weiss, MJ; Soff, GA; Stempel, M; Dematteo, RP; Allen, PJ; Kingham, TP; Fong, Y; Jarnagin, WR; D'Angelica, MI
Published in: J Gastrointest Surg
February 2014

INTRODUCTION: Pharmacologic prophylaxis (PP) is recommended for patients undergoing general surgical procedures with at least moderate risk of venous thromboembolism (VTE). The role of PP in patients undergoing hepatectomy is controversial, however, due to concerns regarding postoperative liver dysfunction and bleeding. METHODS: We conducted a retrospective analysis of a prospectively maintained institutional database in order to clarify the relationship between PP, postoperative INR, and risk of VTE. RESULTS: Postoperative VTE occurred in 55 of 2,147 patients (2.6 %) and was independently associated with advanced age, higher BMI, longer procedure time, and development of a major complication, as well as higher postoperative INR (≥1.5 versus <1.5: OR 2.50, P = 0.006). Patients undergoing more extensive liver resection with higher postoperative INR were less likely to receive PP, but receipt of PP demonstrated no relationship with either VTE incidence or hemorrhagic complications. CONCLUSIONS: In this large single-institution study, incidence of VTE was not associated with PP but was associated with higher postoperative INR, contrary to the notion that postoperative liver dysfunction is protective against VTE. The interplay between prothrombotic and antithrombotic mechanisms in posthepatectomy patients must be more completely characterized before broad recommendations can be made regarding PP use in these patients.

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Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

February 2014

Volume

18

Issue

2

Start / End Page

295 / 302

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • ROC Curve
  • Postoperative Period
  • Operative Time
  • Middle Aged
  • Male
 

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Nathan, H., Weiss, M. J., Soff, G. A., Stempel, M., Dematteo, R. P., Allen, P. J., … D’Angelica, M. I. (2014). Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg, 18(2), 295–302. https://doi.org/10.1007/s11605-013-2383-2
Nathan, Hari, Matthew J. Weiss, Gerald A. Soff, Michelle Stempel, Ronald P. Dematteo, Peter J. Allen, T Peter Kingham, Yuman Fong, William R. Jarnagin, and Michael I. D’Angelica. “Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy.J Gastrointest Surg 18, no. 2 (February 2014): 295–302. https://doi.org/10.1007/s11605-013-2383-2.
Nathan H, Weiss MJ, Soff GA, Stempel M, Dematteo RP, Allen PJ, et al. Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg. 2014 Feb;18(2):295–302.
Nathan, Hari, et al. “Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy.J Gastrointest Surg, vol. 18, no. 2, Feb. 2014, pp. 295–302. Pubmed, doi:10.1007/s11605-013-2383-2.
Nathan H, Weiss MJ, Soff GA, Stempel M, Dematteo RP, Allen PJ, Kingham TP, Fong Y, Jarnagin WR, D’Angelica MI. Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg. 2014 Feb;18(2):295–302.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

February 2014

Volume

18

Issue

2

Start / End Page

295 / 302

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • ROC Curve
  • Postoperative Period
  • Operative Time
  • Middle Aged
  • Male