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01-12-2018 | ORIGINAL ARTICLE

Risk for hemorrhage after pancreatoduodenectomy with venous resection

Authors: Dyre Kleive, Mushegh Sahakyan, Kjetil Søreide, Kristoffer W. Brudvik, Pål-Dag Line, Ivar P. Gladhaug, Knut Jørgen Labori

Published in: Langenbeck's Archives of Surgery | Issue 8/2018

Abstract

Purpose

No consensus exists on the optimal anticoagulation therapy after pancreatoduodenectomy with venous resection (PDVR). The aim of the study was to analyze perioperative outcomes of patients receiving low- vs high-dose anticoagulation therapy and to identify risk factors for postpancreatectomy hemorrhage in patients undergoing PDVR.

Methods

Retrospective study of patients undergoing PDVR at a tertiary referral center between January 2006 and April 2017. Patients were investigated according to the dose of postoperative anticoagulation given (low- or high-dose low-molecular-weight heparin). Uni- and multivariate analysis were performed to assess risk factors for postpancreatectomy hemorrhage.

Results

A total of 141 patients underwent PDVR. Low-dose anticoagulation was given to 45 (31.9%) patients. Operative time (428 min vs 398 min, p = 0.025) and the use of interposition grafts (27% vs 11%, P = 0.033) were significantly higher in the high-dose group. There was no difference in the rate of early portal vein thrombosis (4.4% vs 4.2%, p = 0.939) or postpancreatectomy hemorrhage (13.3% vs 16.7%, p = 0.611) between the low- and high-dose groups. On multivariate analysis, serum bilirubin ≥ 200 μmol/L and clinically relevant postoperative fistula were the only factors associated with postpancreatectomy hemorrhage (OR 10.28, 95% CI 3.51–30.07, P < 0.001, and OR 6.39, 95% CI 1.59–25.74, P = 0.009).

Conclusion

Preoperative hyperbilirubinemia and clinically relevant postoperative fistula are risk factors for postpancreatectomy hemorrhage after PDVR. Rates of postpancreatectomy hemorrhage did not differ between patients receiving high- vs low-dose low-molecular-weight heparin.

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Title: Risk for hemorrhage after pancreatoduodenectomy with venous resection
Authors: Dyre Kleive
Mushegh Sahakyan
Kjetil Søreide
Kristoffer W. Brudvik
Pål-Dag Line
Ivar P. Gladhaug
Knut Jørgen Labori
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1721-y

At a glance: The STEP trials

Springer Medicine

Risk for hemorrhage after pancreatoduodenectomy with venous resection

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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