Liver resection is safely performed in patients receiving antithrombotic therapy

Abstract

Background: This study was to assess the safety and feasibility of liver resection in patients with antithrombotic therapy (ATT, including antiplatelet therapy (APT) and anticoagulation therapy (ACT)) for thromboembolic risks. Methods: 344 patients receiving liver resection at our institution between 2005 and 2016 were retrospectively reviewed. ATT was used in 123 patients (35.8%). Our perioperative management included maintenance of preoperative aspirin monotherapy for APT and bridging heparin for ACT in patients at high thromboembolic risks. Outcomes variables were compared between the patients with ATT and those without ATT . Results: This series included 202 partial liver resection, 66 sectionectomy and 76 lobectomy. Patients with ATT showed high frequency of history of acute coronary syndrome and cerebral infarction, though the type of operation was similar. There were 14 bleeding complications (4.1%) and 6 thromboembolic events (1.7%). No significant differences were found between the groups in operative blood loss and blood transfusion rate. Multiple analysis showed that increased bleeding complications were independently associated with high-risk liver resection (HR 6.125, p=0.004). Poor performance status (HR 14.945, p=0.020) was the significant prognostic factor for thromboembolic events. Neither ACT nor preoperative aspirin continuation affected bleeding or thromboembolism. Conclusion: In patients undergoing ATT, liver resection is safely performed under the relevant perioperative management of ATT.