Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Assess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR). BACKGROUND: Retrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown. METHODS: This multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR. RESULTS: Among 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001). CONCLUSIONS: VR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.
Source: Annals of Surgery
Authors: Peter L. Labib, Siobhan C. McKay, Stéphanie F. Perrodin, Louisa Bolm, Omar A. Mownah, Ruben Bellotti, Jane McClements, Asma Sultana, James RA. Skipworth, Anita Balakrishnan, Manuel Durán, Dimitrios Moris, James A. Milburn, Gökalp K. Kurtoğlu, Nicola De’Liguori Carino, Ismael Domínguez-Rosado, Sanjay Pandanaboyana, Jacob Ghotbi, Giovanni Marchegiani, Tejinderjit S. Athwal, Stefan Stättner, Dimitrios D. Karavias, Bilal Al-Sarireh, Paul D. Morris, Saxon Connor, Asif Halimi, Carl-Stephan Leonhardt, Russell Hodgson, Jaswinder S. Samra, Anubhav Mittal, Oliver M. Fisher, Christopher SH. Lim, Simon W. Banting, Jonathan Koea, Osamu Yoshino, Michael A. Silva, Ricky H. Bhogal, Daniel Croagh, David J. Cavallucci, Benjamin PT. Loveday, Declan FJ. Dunne, Somaiah Aroori, Brian R. Davidson, PVR audit collaborators, Keith J. Roberts
Institutions: Queen Elizabeth Hospital Birmingham, Royal North Shore Hospital, Royal Stoke University Hospital, Royal Liverpool University Hospital, University of Lübeck, Royal London Hospital, Innsbruck Medical University, Universität Innsbruck, Belfast Health and Social Care Trust, Royal Blackburn Teaching Hospital, Bristol Royal Infirmary, Addenbrooke's Hospital, Hospital Universitario Reina Sofía, Duke Medical Center, Aberdeen Royal Infirmary, Acıbadem University, Manchester Royal Infirmary, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Freeman Hospital, Oslo University Hospital, University of Padua, Azienda Ospedale - Università Padova, Johannes Kepler University of Linz, Kepler Universitätsklinikum, Salzburger Landeskliniken, University Hospital Southampton NHS Foundation Trust, Morriston Hospital, Auckland City Hospital, Canberra Hospital, Christchurch Hospital, University Hospital of Umeå, Umeå University, Medical University of Vienna, Northern Health, St George Hospital, St Vincent's Hospital Melbourne, North Shore Hospital, University of Oxford, Oxford University Hospitals NHS Trust, Royal Marsden Hospital, Monash Medical Centre, Monash Health, Wesley Hospital, The Royal Melbourne Hospital, The Royal Free Hospital, Derriford Hospital
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4414531766