Safety of Preoperative Low-Molecular-Weight Heparin in Patients Who Underwent Hepatectomy

Abstract

Background: Although international guidelines advocate preoperative venous thromboembolism (VTE) chemoprophylaxis for hepatectomy, there are still safety concerns. Methods: We conducted a medical chart review of patients who underwent hepatectomy from 2016 to 2020 in a tertiary hospital in Thailand. Our center has applied preoperative chemoprophylaxis protocols with low-molecular-weight heparin (LMWH) since 2018. The rates of post-hepatectomy hemorrhage (PHH) were compared between patients receiving and those not receiving preoperative LMWH. Results: Of 204 patients who underwent hepatectomy, 186 were eligible for the analysis. Moreover, 48% were included in the LMWH group. Major hepatectomies accounted for approximately 50% in both LMWH and No-LMWH groups. The overall PHH rate was 3.8% and was not different between the LMWH (4.4%) and No-LMWH groups (3.1%). PHH was significantly associated with intraoperative blood transfusion > 2 units and post-hepatectomy liver failure. Postoperative VTE developed in 0.5% of patients. Conclusion: No association between PHH and preoperative VTE prophylaxis for hepatectomies was found. Although half of patients in this study underwent major hepatectomies, the PPH rate was low. A single dose of preoperative LMWH plus mechanical thromboprophylaxis may be appropriate in populations with low incidence of VTE. Funding Information: None. Declaration of Interests: None. Ethics Approval Statement: This study was approved by the Prince of Songkla University Hospital Ethics Committee (approval no. REC. 63443101).