Hemorrhagic and Thromboembolic Complications after Hepato-Biliary-Pancreatic Surgery in Patients Receiving Antithrombotic Therapy

Ishida, Jun; Fukumoto, Takumi; Kido, Masahiro; Matsumoto, Ippei; Ajiki, Tetsuo; Kawai, Hiroya; Hirata, Ken-ichi; Ku, Yonson

doi:10.1159/000449105

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…Intra-operative bleeding and peri-operative blood transfusions were associated with higher incidence of postoperative clinically relevant pancreatic fistula and with lower overall survival 671–675 . A retrospective analysis showed that the risks of haemorrhagic and thromboembolic complications after HPB surgery were not increased in patients receiving long-term anticoagulant or antiplatelet therapy 676 . According to a retrospective study, chemical thromboprophylaxis after HPB surgery was safe because it did not increase the risk of major haemorrhage and decreased the risk of pulmonary embolism 677…”

Section: Discussionmentioning

confidence: 99%

“…[671][672][673][674][675] A retrospective analysis showed that the risks of haemorrhagic and thromboembolic complications after HPB surgery were not increased in patients receiving long-term anticoagulant or antiplatelet therapy. 676 According to a retrospective study, chemical thromboprophylaxis after HPB surgery was safe because it did not increase the risk of major haemorrhage and decreased the risk of pulmonary embolism. 677 Cell salvage Intra-operative cell salvage (ICS) can help to avoid the various pitfalls of other blood conservation management strategies, such as multiple preoperative visits for autologous blood donation or complications like intra-operative hypotension with ANH.…”

Section: Prothrombin Complex Concentratementioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

147

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: Prothrombin Complex Concentratementioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

147

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“…The included articles consisted of 9 studies concerning the management of chronically ATT-received patients[ 10 , 17 - 24 ] (Table 2 ) and 10 studies regarding chemical thromboprophylaxis for VTE (Table 3 )[ 25 - 34 ]. Among the studies on the management of chronically ATT-received patients, one was a multicenter retrospective cohort analysis[ 18 ] and another was an analysis using the propensity score matching method[ 21 ]. All 10 articles on chemical thromboprophylaxis for VTE were observational studies, including three prospective and seven retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Safety of pancreatic surgery with special reference to antithrombotic therapy: A systematic review of the literature

Fujikawa¹,

Naito²

2021

WJCC

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BACKGROUND Postpancreatectomy hemorrhage (PPH) is the most severe type of complication after pancreatic surgery, although the effect of antithrombotic therapy (ATT) on PPH is largely unknown. The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism (VTE) remains controversial. AIM To elucidate the effect of ATT on PPH. METHODS Published articles between 2013 and 2020 were searched from PubMed and Google Scholar, and after careful reviewing of all studies, studies concerning ATT and pancreatic surgery were included. Data such as study design, type of surgical procedures, type of antithrombotic drugs, and surgical outcome were extracted from the studies. RESULTS Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review. Fourteen were cohort studies, with only three being prospective in nature. Two studies demonstrated that in patients receiving chronic ATT, which were mostly managed by heparin bridging, the risk of PPH was higher compared with those without ATT, and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others. The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT, even under preoperative aspirin continuation. Concerning chemical thromboprophylaxis for VTE, most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis; however, its effectiveness against VTE has not been statistically demonstrated, particularly among Asian patients. CONCLUSION Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH, although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial. Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.

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Impact of antithrombotic therapy on the outcomes with focus on bleeding and thromboembolic events in patients undergoing pancreticoduodenectomy

Komokata

Aryal

Tada

et al. 2020

ANZ Journal of Surgery

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BackgroundWe investigated perioperative outcomes of pancreaticoduodenectomy (PD) in patients receiving antithrombotic therapy (ATT) with a focus on the incidence of perioperative bleeding and thromboembolic complications.MethodsA total of 77 patients who underwent PD at our institution between 2013 and 2019 were retrospectively reviewed. Clinical findings and surgical outcomes including bleeding and thromboembolic complications were compared in patients with or without ATT. Interruption of ATT and perioperative heparin bridging were based on our hospital protocol.ResultsAmong ATT (30) and non‐ATT (47) groups, ATT group had a significantly higher age and history of cardiocerebrovascular diseases. No significant difference was observed in intraoperative and post‐pancreatectomy haemorrhage (PPH) between the groups. ATT group was associated with a significantly higher rate of post‐operative complications, Clavien–Dindo classification ≥II and thromboembolic events. Operative mortality in ATT and non‐ATT groups was 2 (6.7%) and 1 (2.1%), respectively. There was no significant association between ATT and excessive intraoperative blood loss (≥1000 mL), PPH (≥grade B) and thromboembolic complications (Clavien–Dindo classification ≥II).ConclusionIn patients with ATT, PD is a feasible procedure with no major impact on intraoperative bleeding or PPH.

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Hemorrhagic and Thromboembolic Complications after Hepato-Biliary-Pancreatic Surgery in Patients Receiving Antithrombotic Therapy

Cited by 4 publications

References 23 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Safety of pancreatic surgery with special reference to antithrombotic therapy: A systematic review of the literature

Impact of antithrombotic therapy on the outcomes with focus on bleeding and thromboembolic events in patients undergoing pancreticoduodenectomy

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