Background. Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Methods. Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Results. Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor for PPH after pancreatic surgery (odds ratio 4.77; 95% CI 1.61-14.15; P = .005). Conclusions. Perioperative antithrombotic treatment is an independent risk factor for PPH in patients undergoing pancreatic surgery, although this treatment effectively prevents postoperative thromboembolic events.
YekebasEFWolframLCataldegirmenG. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 cosecutive pancreatic resections. Ann Surg. 2007;246:269-280.
2.
DarnisBLebeauRChopin-LalyXAdhamM.Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Langenbecks Arch Surg. 2013;398:441-448.
3.
Correa-GallegoCBrennanMFD’AngelicaMI. Contemporary experience with postpancreatectomy hemorrhage: results of 1,122 patients resected between 2006 and 2011. J Am Coll Surg. 2012;215:616-621.
4.
JagadRBKoshariyaMKawamotoJChudeGSNeerajRVLygidakisNJ.Postoperative hemorrhage after major pancreatobiliary surgery: an update. Hepatogastroenterology. 2008;55:729-737.
5.
RoulinDCerantolaYDemartinesNSchäferM.Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg. 2011;15:1055-1062.
6.
WelschTEiseleHZschäbitzSHinzUBüchlerMWWenteMN.Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy. Langenbecks Arch Surg. 2011;396:783-791.
7.
GrützmannRRückertFHippe-DaviesNDistlerMSaegerHD.Evaluation of the International Study Group of Pancreatic Surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery. 2012;151:612-620.
8.
RumstadtBSchwabMKorthPSammanMTredeM.Hemorrhage after pancreatoduodenectomy. Ann Surg. 1998;227:236-241.
9.
RicciCCasadeiRBuscemiSMinniF.Late postpancreatectomy hemorrhage after pancreaticoduodenectomy: is it possible to recognize risk factors?JOP. 2012;13:193-198.
10.
SanjayPFawziAFulkeJL. Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP. 2010;11:220-225.
11.
NakaharaOTakamoriHIkedaO. Risk factors associated with delayed haemorrhage after pancreatic resection. HPB (Oxford). 2012;14:684-687.
12.
ThachilJGattAMartlewV.Management of surgical patients receiving anticoagulation and antiplatelet agents. Br J Surg. 2008;95:1437-1448.
13.
WenteMNVeitJABassiC. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20-25.
14.
DouketisJDJohnsonJATurpieAG.Low-molecular-weight heparin as bridging anticoagulation during interruption of warfarin: assessment of a standardized periprocedural anticoagulation regimen. Arch Intern Med. 2004;164:1319-1326.
15.
DunnASSpyropoulosACTurpieAG.Bridging therapy in patients on long-term oral anticoagulants who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost. 2007;5:2211-2218.
16.
AnsellJE.The perioperative management of warfarin therapy. Arch Intern Med. 2003;163:881-883.
17.
ChassotPGDelabaysASpahnDR.Perioperative use of anti-platelet drugs. Best Pract Res Clin Anaesthesiol. 2007;21:241-256.
18.
SilberSAlbertssonPAvilésFF. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804-847.
19.
FleisherLABeckmanJABrownKA. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 2007;116:e418-e499.
20.
MitaKItoHMurabayashiR. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol. 2012;19:3745-3752.
21.
RicciCCasadeiRTaffurelliG. Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg. 2015;19:770-781.
22.
MehrabiAHafeziMArvinJ. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery. 2015;157:45-55.
23.
BassiCDervenisCButturiniG. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8-13.
24.
VarkarakisIMRais-BahramiSAllafME. Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. J Urol. 2005;174:1020-1023.
25.
ErcanMBostanciEBOzerI.Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy. Langenbecks Arch Surg. 2010;395:247-253.
26.
IqbalCWCimaRRPembertonJH.Bleeding and thromboembolic outcomes for patients on oral anticoagulation undergoing elective colon and rectal abdominal operations. J Gastrointest Surg. 2011;15:2016-2022.
27.
MoureloRKaidar-PersonOFajnwaksP. Hemorrhagic and thromboembolic complications after bariatric surgery in patients receiving chronic anticoagulation therapy. Obes Surg. 2008;18:167-170.
28.
JeongORyuSYParkYK.The effect of low molecular weight heparin thromboprophylaxis on bleeding complications after gastric cancer surgery. Ann Surg Oncol. 2010;17:2363-2369.
29.
BurgerWChemnitiusJMKneisslGDRückerG.Low-dose aspirin for secondary cardiovascular prevention—cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation—review and meta-analysis. J Intern Med. 2005;257:399-414.
30.
EikelboomJWHirschJ.Bleeding and management of bleeding. Eur Heart J. 2006;8:38-45.
31.
AlcockRFNaoumCAliprandi-CostaBHillisGSBriegerDB.The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery. Int J Cardiol. 2013;167:374-377.
32.
ManganoDTBrownerWSHollenbergMLondonMJTubauJFTateoIM.Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990;323:1781-1788.
33.
BrancatiMFGiammarinaroMBurzottaF. Outcome of non-cardiac surgery after stent implantation in the DES era: results of the Surgery After Stent (SAS) registry. J Invasive Cardiol. 2011;23:44-49.
34.
AlbaladejoPMarretESamamaCM. Non-cardiac surgery in patients with coronary stents: the RECO study. Heart. 2011;97:1566-1572.
35.
GuyattGHAklEACrowtherMGuttermanDDSchuünemannHJ.Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):7S-47S.
