The incidence of clinically significant venous thromboembolism in an Asian population after major hepatobiliary and pancreatic surgery

Abstract

Introduction: The incidence of venous thromboembolism (VTE) is not well defined in Asian population after major hepatobiliary and pancreatic (HPB) surgery. The use of pharmacological prophylaxis is debatable due to postoperative coagulopathy. Aim: To determine the incidence of clinically significant VTE events in Asian undergoing major HPB surgery. Methods: A retrospective review of patients undergoing major HPB surgery between January 2010 to August 2013 at Tan Tock Seng Hospital, Singapore was conducted. Clinical notes and radiology reports were reviewed to screen for patients who developed VTE. A secondary endpoint was 30-day and 90-day mortality. Results: 224 patients had major HPB surgery with median age of 61 years and BMI of 22.3. 143 patients were male. Majority of the patients were Chinese and most underwent open hepatic surgery for malignancy. A few had a past history of VTE. No patient developed DVT, whilst a single patient was diagnosed with pulmonary embolus. There were two unexpected deaths within 90 days of surgery and neither appeared to be VTE-related. Statistical tests comparing our results with reported baseline VTE risk in literature and risk with chemoprophylaxis would suggest the low incidence found in this study was comparable to Western patients given chemoprophylaxis. Conclusion: The risk of VTE appears low in Asian patients undergoing major HPB surgery. Hence, one must consider if the benefits of low molecular weight heparin does indeed outweigh the risks.