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. 2025 Sep 25.
doi: 10.1097/SLA.0000000000006954. Online ahead of print.

Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study

Peter L Labib  1 , Siobhan C McKay  2   3 , Stéphanie F Perrodin  4 , Louisa Bolm  5 , Omar A Mownah  6 , Ruben Bellotti  7 , Jane McClements  8 , Asma Sultana  9 , James Ra Skipworth  10 , Anita Balakrishnan  11 , Manuel Durán  12 , Dimitrios Moris  13 , James A Milburn  14 , Gökalp K Kurtoğlu  15 , Nicola De'Liguori Carino  16 , Ismael Domínguez-Rosado  17 , Sanjay Pandanaboyana  18 , Jacob Ghotbi  19 , Giovanni Marchegiani  20 , Tejinderjit S Athwal  21 , Stefan Stättner  7   22   21 , Dimitrios D Karavias  23 , Bilal Al-Sarireh  24 , Paul D Morris  25   26 , Saxon Connor  27 , Asif Halimi  28 , Carl-Stephan Leonhardt  29 , Russell Hodgson  30 , Jaswinder S Samra  2 , Anubhav Mittal  2 , Oliver M Fisher  31 , Christopher Sh Lim  26 , Simon W Banting  32 , Jonathan Koea  33 , Osamu Yoshino  3 , Michael A Silva  34 , Ricky H Bhogal  35 , Daniel Croagh  36 , David J Cavallucci  37 , Benjamin Pt Loveday  38 , Declan Fj Dunne  39 , Somaiah Aroori  40 , Brian R Davidson  39 , Keith J Roberts  1 ; PVR audit collaborators
Collaborators, Affiliations

Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study

Peter L Labib et al. Ann Surg. .

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.

Keywords: anticoagulants; pancreatectomy; pancreatic neoplasms; portal vein; survival; venous thrombosis.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare. The authors received no financial support for the research, authorship, or publication of this article.

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