SP2.8 AnTIcoaGulation afteR pancreatic surgery with vEnouS reSection (TIGRESS): what should we do? Results from an international survey

Abstract

Abstract Aims Patients who undergo pancreatic surgery with venous resection/reconstruction (PSVRR) have high rates of morbidity/mortality and are at risk of postoperative venous thromboembolism (VTE). It is unknown if this group should be routinely anticoagulated. We developed a survey to establish current anticoagulation practices among pancreatic surgeons. Methods A JotForm.com survey was sent to members of various hepatopancreatobiliary societies. Questions covered: centre volume, venous resection/reconstruction techniques, and anticoagulation policies. Results Sixty-five centres from 17 seventeen countries responded. Following a “side-bite” venous resection and patch repair, 40% use an autologous vein patch, 27% use peritoneum and 27% use a bovine patch. When formally resecting a segment of vein, 17% of centres use an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (PTFE, 73%) grafts are the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a “side-bite” resection with patch repair, 59%, 28%, and 19% of centres provide therapeutic anticoagulation (TAG), respectively. Among the units that provide TAG, most (66%) use low molecular weight heparin. The duration of therapy provided varies from inpatient stay only (14%) to six months (32%). Conclusions Our global survey indicates that anticoagulation practices following PSVRR are highly variable. The centres do not agree on when or how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity on these issues.