Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
HPB (Oxford). 2021 Jul;23(7):1016-1024. doi: 10.1016/j.hpb.2020.10.018. Epub 2020 Nov 19.
Thromboprophylaxis protocols in liver surgery vary greatly worldwide. Due to limited research, there is no consensus whether the administration of thromboprophylaxis should be initiated pre- or postoperatively.
Patients undergoing liver resection in Helsinki University Hospital between 2014 and 2017 were reviewed retrospectively. Initiation of thromboprophylaxis was changed in the institution in the beginning of 2016 from postoperative to preoperative. Patients were classified into two groups for analyses: thromboprophylaxis initiated preoperatively (Preop-group) or postoperatively (Postop-group). The incidences of VTE and haemorrhage within 30 days of surgery were compared between these groups. Patients with permanent anticoagulation were excluded.
A total of 512 patients were included to the study (Preop, n = 253, Postop, n = 259). The incidence of VTE was significantly lower in the Preop-group compared to the Postop-group (3 (1.2%) vs. 25 (9.7%), P = <.0001), mainly due to a lower incidence of pulmonary embolisms in the Preop-group (3 (1.2%) vs. 24 (9.3%), P < .0001). The rates of posthepatectomy haemorrhage within 30 days of surgery were similar (Preop 38 (15.0%) vs. Postop 36 (13.9%), p = .719).
Initiating thromboprophylaxis preoperatively may reduce the incidence of postoperative VTE without affecting the incidence of posthepatectomy haemorrhage in patients undergoing liver resection.
全球范围内，肝外科的血栓预防方案差异很大。由于研究有限，对于预防性抗凝应在术前还是术后开始，目前尚无共识。
回顾性分析了 2014 年至 2017 年期间在赫尔辛基大学医院行肝切除术的患者。该机构于 2016 年初改变了预防性抗凝的起始方式，从术后改为术前。将患者分为两组进行分析：术前开始（Preop 组）或术后开始（Postop 组）。比较两组术后 30 天内 VTE 和出血的发生率。排除接受永久性抗凝治疗的患者。
共有 512 例患者纳入研究（Preop 组 n=253，Postop 组 n=259）。Preop 组的 VTE 发生率明显低于 Postop 组（3（1.2%）比 25（9.7%），P<.0001），主要是因为 Preop 组肺栓塞发生率较低（3（1.2%）比 24（9.3%），P<.0001）。术后 30 天内肝切除术后出血的发生率相似（Preop 组 38（15.0%）比 Postop 组 36（13.9%），p=0.719）。
在肝切除术患者中，术前开始预防性抗凝可能会降低术后 VTE 的发生率，而不会影响术后出血的发生率。
