Low Level of Postoperative Plasma Antithrombin III Is Associated with Portal Vein Thrombosis after Liver Surgery

Abstract

Background: Decreased antithrombin-III (AT-III) is a risk factor of portal vein thrombosis (PVT) in patients with liver cirrhosis. The association between PVT and postoperative AT-III is controversial in patients who underwent liver surgery. The efficacy of postoperative AT-III supplementation on PVT is also uncertain. Methods: Patients who underwent hepatectomy for hepato-biliary disease between 2015-2018 were retrospectively analyzed. Donors and recipients for liver transplantation were excluded. Postoperative PVT was assessed on computed tomography on the day 6-9 after hepatectomy. Results: Of the 325 patients included in this analysis, 19 patients (5.8%) were diagnosed as postoperative PVT. AT-III level on postoperative day (POD) 3 predicted postoperative PVT with a sensitivity/specificity of 74%/59% (area under the curve, 0.644; cut-off value, 60%; p=0.032). Univariate analysis revealed that AT-III level ≤60% on POD3 was the only significant risk factor for postoperative PVT (Table). Postoperative AT-III supplementation was not associated with reduced incidence of PVT. Although postoperative AT-III supplementation and major hepatectomy were the significant risk factors for postoperative hemorrhagic complications in univariate analysis, multivariate analysis revealed that major hepatectomy was the only significant risk factor for hemorrhagic complications. Conclusion: Patients with AT-III level ≤60% on POD3 should be given careful attention to postoperative PVT. Although postoperative supplementation of AT-III is safe without increased risk of hemorrhagic complication, the efficacy of it on PVT is still controversial.