Venous thromboembolic prophylaxis after a hepatic resection: Patterns of care among liver surgeons

Matthew J. Weiss, Yuhree Kim, Aslam Ejaz, Gaya Spolverato, Elliott R. Haut, Kenzo Hirose, Christopher L. Wolfgang, Michael A. Choti, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Introduction: No consensus exists for post-hepatectomy venous thromboembolic (VTE) prophylaxis. Factors impacting VTE prophylaxis patterns among hepato-pancreato-biliary (HPB) surgeons were defined. Method: Surgeons were invited to complete a web-based survey on VTE prophylaxis. The impact of physician and clinical factors was analysed. Results: Two hundred responses were received. Most respondents were male (91%) and practiced at academic centres (88%) in the United States (80%). Surgical training varied: HPB (24%), transplantation (24%), surgical oncology (34%), HPB/transplantation (13%), or no specialty (5%). Respondents estimated VTE risk was higher after major (6%) versus minor (3%) resections. Although 98% use VTE prophylaxis, there was considerable variability: sequential compression devices (SCD) (91%), unfractionated heparin Q12h (31%) and Q8h (32%), and low-molecular weight heparin (39%). While 88% noted VTE prophylaxis was not impacted by operative indication, 16% stated major resections reduced their VTE prophylaxis. Factors associated with the decreased use of pharmacologic prophylaxis included: elevated international normalized ratio (INR) (74%), thrombocytopaenia (63%), liver insufficiency (58%), large EBL (46%) and complications (8%). Forty-seven per cent of respondents wait until ≥post-operative day 1 (POD1) and 35% hold pharmacologic VTE prophylaxis until no signs of coagulopathy. A minority (14%) discharge patients on pharmacologic prophylaxis. While 81% have institutional VTE guidelines, 79% believe hepatectomy-specific guidelines would be helpful. Conclusion: There is considerable variation regarding VTE prophylaxis among liver surgeons. While most HPB surgeons employ VTE prophylaxis, the methods, timing and purported contraindications differ significantly.

Original languageEnglish (US)
Pages (from-to)892-898
Number of pages7
Issue number10
StatePublished - 2014

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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