Anticoagulation policy after venous resection with a pancreatectomy: a systematic review. Issue 8 (18th December 2013)

• Record Type: Journal Article
• Authors: Chandrasegaram, Manju D.; Eslick, Guy D.; Lee, Wayne; Brooke‐Smith, Mark E; Padbury, Rob; Worthley, Christopher S; Chen, John W; Windsor, John A
• Is Part Of: HPB. Volume 16:Issue 8(2014:Aug.)
• Page Start: 691
• Page End: 698
• Publication Date: 2013-12-18
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12205
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12205-sec-0001" sec-type="section"> <title>Background</title> <p>Portal vein (PV) resection is used increasingly in pancreatic resections. There is no agreed policy regarding anticoagulation.</p> </sec> <sec id="hpb12205-sec-0002" sec-type="section"> <title>Methods</title> <p>A systematic review was performed to compare studies with an anticoagulation policy (AC+) to no anticoagulation policy (AC−) after venous resection.</p> </sec> <sec id="hpb12205-sec-0003" sec-type="section"> <title>Results</title> <p>There were eight AC+ studies (<italic>n</italic> = 266) and five AC− studies (<italic>n</italic> = 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 <italic>P</italic> < 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 <italic>P</italic> = 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 <italic>P</italic> = 0.621).</p> </sec> <sec id="hpb12205-sec-0004" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>