Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2010; 16(17): 2146-2150
Published online May 7, 2010. doi: 10.3748/wjg.v16.i17.2146
Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: Is it necessary?
Marco Vivarelli, Matteo Zanello, Chiara Zanfi, Alessandro Cucchetti, Matteo Ravaioli, Massimo Del Gaudio, Matteo Cescon, Augusto Lauro, Eva Montanari, Gian Luca Grazi, Antonio Daniele Pinna
Marco Vivarelli, Matteo Zanello, Chiara Zanfi, Alessandro Cucchetti, Matteo Ravaioli, Massimo Del Gaudio, Matteo Cescon, Augusto Lauro, Gian Luca Grazi, Antonio Daniele Pinna, Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy
Eva Montanari, Institute of Forensic Medicine, University of Bologna, Via Irnerio 49, 40100 Bologna, Italy
Author contributions: Vivarelli M designed and wrote the study; Zanello M and Zanfi C collected the data; Cucchetti A performed the data analysis; Ravaioli M, Del Gaudio M, Cescon M and Lauro A participated in the data collection; Montanari E provided forensic expertise; Grazi GL reviewed the paper; Pinna AD coordinated the study.
Correspondence to: Dr. Marco Vivarelli, Department of Surgery and Transplantation, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy. marco.vivarelli@aosp.bo.it
Telephone: +39-51-6363721 Fax: +39-51-397661
Received: January 20, 2010
Revised: March 3, 2010
Accepted: March 10, 2010
Published online: May 7, 2010
Abstract

AIM: To assess the safety and effectiveness of prophylaxis for venous thromboembolism (VTE) in a large population of patients with hepatocellular carcinoma (HCC) on cirrhosis.

METHODS: Two hundred and twenty nine consecutive cirrhotic patients with HCC who underwent hepatic resection were retrospectively evaluated to assess whether there was any difference in the incidence of thrombotic or hemorrhagic complications between those who received and those who did not receive prophylaxis with low-molecular weight heparin. Differences and possible effects of the following parameters were investigated: age, sex, Child-Pugh and model for end-stage liver disease (MELD) score, platelet count, presence of esophageal varices, type of hepatic resection, duration of surgery, intraoperative transfusion of blood and fresh frozen plasma (FFP), body mass index, diabetes and previous cardiovascular disease.

RESULTS: One hundred and fifty seven of 229 (68.5%) patients received antithromboembolic prophylaxis (group A) while the remaining 72 (31.5%) patients did not (group B). Patients in group B had higher Child-Pugh and MELD scores, lower platelet counts, a higher prevalence of esophageal varices and higher requirements for intraoperative transfusion of FFP. The incidence of VTE and postoperative hemorrhage was 0.63% and 3.18% in group A and 1.38% and 1.38% in group B, respectively; these differences were not significant. None of the variables analyzed including prophylaxis proved to be risk factors for VTE, and only the presence of esophageal varices was associated with an increased risk of bleeding.

CONCLUSION: Prophylaxis is safe in cirrhotic patients without esophageal varices; the real need for prophylaxis should be better assessed.

Keywords: Hepatic surgery, Hepatocellular carcinoma, Liver cirrhosis, Postoperative bleeding, Postoperative thromboembolism, Venous thromboembolism prophylaxis