Impact of laparoscopic liver resection on bleeding complications in patients receiving antithrombotics

Figure 1 Consort diagram in the current study. Pts: Patients; ATT: Antithrombotic therapy; LLR: Laparoscopic liver resection; OLR: Open liver resection.

Figure 2 Perioperative management protocol (“Kokura Protocol”) for patients undergoing antithrombotic therapy in case of elective surgery. The management generally consists of interrupting ATT 5 to 7 d before surgery and early postoperative reinstitution in low thromboembolic risk patients. In patients with high thromboembolic risks, aspirin monotherapy is continued in patients with APT, and/or ACT was substituted by bridging heparin. ATT: Antithrombotic therapy; APT: Antiplatelet therapy; ACT: Anticoagulation therapy; Ope.: Operation; ASA: Aspirin; TPs: Thienopyridines.

Figure 3 Forest plots showing hazard ratios of increased surgical blood loss. A: Hazard ratios in the whole cohort (n = 258); B: Hazard ratios in the ATT group (n = 100). HR: Hazard ratio; ATT: Antithrombotic therapy; APT: Antiplatelet therapy; HCC: Hepatocellular carcinoma; ASA: American Society of Anesthesiolgists; CI: Cerebral infarction.