Antiplatelet therapy after pancreaticoduodenectomy with portal vein resection may be the optimal anticoagulatant

Abstract

Background: Choice of postoperative anticoagulation after pancreaticoduodenectomy with portal vein resection (PDVR) is important in maintaining vein patency. In this study, patients undergoing PDVR were evaluated to determine optimal anticoagulation regimen. Methods: A total of 70 patients underwent PDVR; those with pancreatic adenocarcinoma (PC) were retrospectively analyzed. Patients were divided into three groups: tangential resection (TR), segmental resection with primary anastomosis (SR), and segmental resection with vein graft (VG). Type of anticoagulation included: None, antiplatelet therapy (AP), and low molecular weight heparin bridge with warfarin (W). The primary outcome measure was vein patency at 2, 4, and 6 months. Results: 35 patients underwent PDVR for PC: 7 with TR, 18 with SR, and 10 with VG. 2, 4, and 6-month vein patency was 91.4%, 90%, 89.2%, respectively. Amongst TR patients, all 7 patients (None and AP) demonstrated vein patency at 6 months. In the SR group, vein patency was 81.8% with AP and 20% with None. In the VG group, vein patency was 80% with AP and 60% with W. Conclusion: For patients undergoing PDVR for PC, TR may not require any AC while SR patients may benefit from AC. In VG patients, anticoagulation can either be antiplatelet or warfarin therapy.