Effect of Perioperative Antiplatelet Management on Thromboembolic Complications after Liver Resection

Abstract

AIM: The aim of the study was to specify the effect of perioperative antiplatelet (APT) management on postoperative thromboembolism (TE) after livr resection.

METHODS: Consecutive 398 patients undergoing liver resection at our hospital from 2005 to 2017 were retrospectively reviewed. Our perioperative antithrombotic management protocol includes preoperative aspirin monotherapy for patients with high thromboembolic risks. Among them, 125 patients (31.4%) had atherosclerotic thromboembolic risk and received APT. The cohort was classified into three groups; patients without APT (N-APT group), APT-discontinued patients (D-APT group), and aspirin-continued patients (C-APT group), The predicted risk of each group was assessed by CHADS2 score, and the rates of TE were compared between the groups.

RESULTS: Significantly lower CHADS2 score of N-APT group was observed compared to those of other groups, although the D-APT and C-APT groups had similar distribution of the scores. Among 398 patients, postoperative TE was found in 6 cases (1.5%). Three cases resulted in in-hospital death and other 3 patients were discharged with moderate to severe sequelae. More TE occurred in the D-APT group (4.2%), whereas only one case in the C-APT group (1.9%) and three cases in the N-APT group (0.7%) were observed (p=0.038). Although having high CHADS2 scores, patients in C-APT group showed a relatively low rate of postoperative TE events, mainly due to the preventive effect of preoperative aspirin continuation against TE.

CONCLUSION: Liver resection should be performed under rigid perioperative antithrombotic management in order to avoid thromboembolic complications. Especially in patients with APT for thrombotic risks, it is suggested that management with continued preoperative single aspirin therapy should be considered regardless of TE risks.