Your browser doesn't support javascript.
loading
Outcomes following pancreatic surgery using three different thromboprophylaxis regimens.
Hanna-Sawires, R G; Groen, J V; Klok, F A; Tollenaar, R A E M; Mesker, W E; Swijnenburg, R J; Vahrmeijer, A L; Bonsing, B A; Mieog, J S D.
Afiliação
  • Hanna-Sawires RG; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Groen JV; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Klok FA; Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
  • Tollenaar RAEM; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Mesker WE; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Swijnenburg RJ; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Vahrmeijer AL; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Bonsing BA; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
  • Mieog JSD; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
Br J Surg ; 106(6): 765-773, 2019 05.
Article em En | MEDLINE | ID: mdl-30776085
ABSTRACT

BACKGROUND:

Postpancreatectomy haemorrhage (PPH) and venous thromboembolism (VTE) are serious complications following pancreatic surgery. The aim was to assess the timing, occurrence and predictors of PPH and VTE.

METHODS:

Elective pancreatic resections undertaken in a single university hospital between November 2013 and September 2017 were assessed. Three intervals were reviewed, each with a different routine regimen of nadroparin 2850 units once daily (single dose) administered in hospital only, or 5700 units once daily (double dose) or 2850 units twice daily (split dose) administered in hospital and continued for 6 weeks after surgery. Clinically relevant PPH (CR-PPH) was classified according to International Study Group of Pancreatic Surgery criteria. VTE was defined according to a number of key diagnostic criteria within 6 weeks of surgery. Cox regression analyses were performed to test the hypotheses that the double-dose group would experience more PPH than the other two groups, the single-dose group would experience more VTE than the other two groups, and the split-dose group would experience the fewest adverse events (PPH or VTE).

RESULTS:

In total, 240 patients were included, 80 per group. The double-dose group experienced significantly more CR-PPH (hazard ratio (HR) 2·14, 95 per cent c.i. 1·16 to 3·94; P = 0·015). More relaparotomies due to CR-PPH were performed in the double-dose group (16 versus 3·8 per cent; P = 0·002). The single-dose group did not experience more VTE (HR 1·41, 0·43 to 4·62; P = 0·570). The split dose was not associated with fewer adverse events (HR 0·77, 0·41 to 1·46; P = 0·422). Double-dose low molecular weight heparin (LMWH), high BMI and pancreatic fistula were independent predictors of CR-PPH.

CONCLUSION:

A double dose of LMWH prophylaxis continued for 6 weeks after pancreatic resection was associated with a twofold higher rate of CR-PPH, resulting in four times more relaparotomies. Patients receiving a single daily dose of LMWH in hospital only did not experience a higher rate of VTE.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatectomia / Cuidados Pós-Operatórios / Pancreaticoduodenectomia / Nadroparina / Hemorragia Pós-Operatória / Tromboembolia Venosa / Anticoagulantes Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatectomia / Cuidados Pós-Operatórios / Pancreaticoduodenectomia / Nadroparina / Hemorragia Pós-Operatória / Tromboembolia Venosa / Anticoagulantes Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article