INCIDENCE AND RISK FACTORS OF VENOUS THROMBOEMBOLIC DISEASE AND THROMBOSIS PORTAL IN PATIENTS COURSING POSTOPERATIVE HEPATECTOMY IN A THIRD LEVEL CENTER: COHORTE STUDY

MARIA LOURDES POSADAS MARTINEZ; ET AL

Congreso; 25th Biennial International Congress on Thronbosis,; 2018

Autores: Trobbiani JI1, Peuchot V2, ,Posadas Martinez ML2, Fernando Vazquez, Diego Giunta, Quiros FB ,Iaquinandi JC1,¬ Pekolj J1, de Santibañes M1Background: Thromboembolic disease (VTE) is one of the main complications in the postoperative of abdominal surgeries, with high morbidity and mortality and health costs. The use of thromboprophylaxis in patients with chronic liver disease decreases the risk of VTE without increasing complications due to bleeding. However, the indication of thromboprophylaxis in patients with hepatectomy is still controversial, especially because of the potential risk of postoperative bleeding.Aim: To determine the incidence of thrombotic events (deep vein thrombosis (DVT) / pulmonary thromboembolism (PTE) and portal thrombosis (PT)) in patients undergoing postoperative hepatectomy and to identify associated risk factors.MethodsProspective cohort of all consecutive adult patients with hepatectomies during April 2012 and August 2015. Each patient was followed for 90 days or until the occurrence of the event of interest (DVT / PE, PT and / or death). Incident cases of DVT and PE were captured from the Institutional Registry of Thromboembolic disease. Factors associated with VTE were analyzed with a logistic regression model.Results: during theperiod of interest, 287 patients were studied. 56% of the patients in the series (n = 161) received chemical thromboprophylaxis, which started on average 48 hours after surgery. The incidence of global VTE (TVP and / or TEP) was 5% (n = 15, 95% CI 3-8). The incidence of DVT and PE was 4% (n = 12, 95% CI 2-7%) and 3% (n = 8, 95% CI 1-5%) respectively. TEP is diagnosed in 1 in 2 patients with DVT. The incidence of PD was 2.4% (n = 7, 95% CI 0.9-4.9). The risk factors for the development of VTE were surgery time, prolonged hospitalization and the presence of complications. Surgeries larger than 4 hours multiply by 5 the risk of ETV compared to surgeries performed in less time (OR 5.62 IC95% 1.55-20.40). Patients with hospitalizations greater than 7 days had a 4 times higher risk of presenting thrombotic events (OR 4.11 IC95% 1.30-13) compared to those with shorter hospitalizations. The presence of postoperative complications increases the risk of suffering DVT / TEP by 4 times after adjusting with confounding factors (OR 3.9 CI 95% 1,2-13).Conclusions: The incidence of post-hepatectomy VTE is high in this patients The subgroup of patients with complicated postoperative procedures should be considered a high risk group for thrombotic events and could be a reason for new research, deepening earlier and more aggressive diagnostic and therapeutic measures for this disease.