Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study

David S Liu^{1

2

3

4

5}, Ryan Newbold⁶, Sean Stevens^{6

7

8}, Enoch Wong⁹, Jonathan Fong⁶, Krinal Mori^{6

10

11}, Darren J Wong^{8

12}, Anna Sonia Gill⁶, Sharon Lee¹⁰, Wael Jamel⁶, Amy Crowe⁹, Tess Howard⁶, Anshini Jain⁹, Pith Soh Beh¹⁰, Maeve Slevin¹⁰, Nicola Fleming⁶, Simon Bennet⁶, Chi Chung⁹; VERITAS collaborative

Affiliations

¹ Division of Surgery, Anaesthetics and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
² Department of Surgery, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia. liu.davidsh@gmail.com.
³ Department of Surgery, The University of Melbourne, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
⁴ Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. liu.davidsh@gmail.com.
⁵ General and Gastrointestinal Surgery Research Group, Austin Precinct, Department of Surgery, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
⁶ Division of Surgery, Anaesthetics and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁷ Department of Surgery, The University of Melbourne, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁸ General and Gastrointestinal Surgery Research Group, Austin Precinct, Department of Surgery, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁹ Department of Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Victoria, 3128, Australia.
¹⁰ Department of Surgery, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.
¹¹ Department of Surgery, The University of Melbourne, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.
¹² Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.

PMID: 35318594
PMCID: PMC9296430
DOI: 10.1007/s11605-022-05301-4

Multicenter Study

Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study

David S Liu et al. J Gastrointest Surg. 2022 Jul.

. 2022 Jul;26(7):1495-1502.

doi: 10.1007/s11605-022-05301-4. Epub 2022 Mar 22.

Authors

Affiliations

¹ Division of Surgery, Anaesthetics and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
² Department of Surgery, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia. liu.davidsh@gmail.com.
³ Department of Surgery, The University of Melbourne, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
⁴ Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. liu.davidsh@gmail.com.
⁵ General and Gastrointestinal Surgery Research Group, Austin Precinct, Department of Surgery, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. liu.davidsh@gmail.com.
⁶ Division of Surgery, Anaesthetics and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁷ Department of Surgery, The University of Melbourne, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁸ General and Gastrointestinal Surgery Research Group, Austin Precinct, Department of Surgery, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁹ Department of Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Victoria, 3128, Australia.
¹⁰ Department of Surgery, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.
¹¹ Department of Surgery, The University of Melbourne, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.
¹² Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.

PMID: 35318594
PMCID: PMC9296430
DOI: 10.1007/s11605-022-05301-4

Abstract

Background: Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of perioperative chemical thromboprophylaxis, the most appropriate time for its initiation is unknown. Here, we investigated whether early (before skin closure) versus postoperative commencement of chemoprophylaxis affected VTE and bleeding rates following abdominal visceral resection.

Methods: Retrospective review of all elective abdominal visceral resections undertaken between January 1, 2018, and June 30, 2019, across four tertiary-referral hospitals. Major bleeding was defined as the need for blood transfusion, reintervention, or > 20 g/L fall in hemoglobin from baseline. Clinical VTE was defined as imaging-proven symptomatic disease < 30 days post-surgery.

Results: A total of 945 cases were analyzed. Chemoprophylaxis was given early in 265 (28.0%) patients and postoperatively in 680 (72.0%) patients. Mean chemoprophylaxis exposure doses were similar between the two groups. Clinical VTE developed in 14 (1.5%) patients and was unrelated to chemoprophylaxis timing. Postoperative bleeding occurred in 71 (7.5%) patients, with 57 (80.3%) major bleeds, requiring blood transfusion in 48 (67.6%) cases and reintervention in 31 (43.7%) cases. Bleeding extended length-of-stay (median (IQR), 12 (7-27) versus 7 (5-11) days, p < 0.001). Importantly, compared to postoperative chemoprophylaxis, early administration significantly increased the risk of bleeding (10.6% versus 6.3%, RR 1.45, 95% CI 1.05-1.93, p = 0.038) and independently predicted its occurrence.

Conclusions: The risk of bleeding following elective abdominal visceral resections is substantial and is higher than the risk of clinical VTE. Compared with early chemoprophylaxis, postoperative initiation reduces bleeding risk without an increased risk of clinical VTE.

Keywords: Chemoprophylaxis; Laparotomy; Thromboembolism; Timing.

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Conflict of interest statement

The authors declare no competing interests.

References

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1. Liu DS, Stevens S, Wong E, Fong J, Mori K, Ward S, et al. Pre-operative and intra-operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study. ANZ J Surg. 2020;90(12):2449–2455. doi: 10.1111/ans.15998. - DOI - PubMed

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Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study

Affiliations

Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study

Authors

Affiliations

Abstract

Conflict of interest statement

References

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LinkOut - more resources

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