Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Anticoagulation after pancreatic surgery with venous resection (TIGRESS): What should we do? Results from an international survey

  • Thomas B. Russell (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Debora Ciprani (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Somaiah Aroori (Department of HPB Surgery, University Hospitals Plymouth NHS Trust)
  • Received : 2023.05.18
  • Accepted : 2023.06.08
  • Published : 2023.11.30
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Abstract

Backgrounds/Aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices. Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies. Results: Sixty-five centers from 17 countries responded. Following a "side-bite" venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a "side-bite" resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%). Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.

Keywords

Acknowledgement

We would like to thank those who took the time to complete the TIGRESS survey. The results outlined in this paper were presented as an oral presentation at ASGBI Congress 2023 (Harrogate, UK) and as a poster presentation at E-AHPBA Congress 2023 (Lyon, France).

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