Abstract
Background: Current guidelines recommend chemical thrombo-prophylaxis for patients undergoing abdominal surgery for malignancy. Liver resection exposes patients to risk factors for venous thrombo-embolism (VTE), but also peri-operative bleeding. This study evaluates the evidence base supporting the use of chemical prophylaxis in liver surgery. Methods: An electronic search was carried out for studies reporting outcome data for patients undergoing liver resection comparing patients receiving chemical prophylaxis with those who did not. The search resulted in 990 unique citations. Following the application of eligibility criteria 5 studies comprise the final study population. Results: 3675 patients underwent liver resection between 1999 and 2013. 2256 patients received chemical prophylaxis, 1412 had only mechanical prophylaxis and 7 received no prophylaxis. Meta-analysis revealed lower VTE rates in patients receiving chemical prophylaxis (2.6%) compared to without chemical prophylaxis (4.6%) (Odds Ratio: 0.631 [95% Cl: 0.416–0.959], Fixed model, p=0.030). Data regarding bleeding could not be pooled for meta-analysis, but chemical prophylaxis was reported as safe in 4 studies. Conclusion: This meta-analysis indicates that the use of chemical prophylaxis reduces VTE incidence following liver surgery. 4 studies report no increase in bleeding associated with chemical prophylaxis use. Better quality data are required to support guidelines relating to optimum timing and duration of treatment.
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