Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study
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Labib,Peter L.;McKay,Siobhan C.;Perrodin,Stéphanie F.;Bolm,Louisa;Mownah,Omar A.;Bellotti,Ruben;McClements,Jane;Sultana,Asma;Skipworth,James Ra;Balakrishnan,Anita;Durán,Manuel;Moris,Dimitrios;Milburn,James A.;KurtoÄŸlu,Gökalp K.;Carino,Nicola De'Liguori;DomÃnguez-Rosado,Ismael;Pandanaboyana,Sanjay;Ghotbi,Jacob;Marchegiani,Giovanni;Athwal,Tejinderjit S.;Stättner,Stefan;Karavias,Dimitrios D.;Al-Sarireh,Bilal;Morris,Paul D.;Connor,Saxon;Halimi,Asif;Leonhardt,Carl-Stephan;Hodgson,Russell;Samra,Jaswinder S.;Mittal,Anubhav;Fisher,Oliver M.;Lim,Christopher Sh;Banting,Simon W.;Koea,Jonathan;Yoshino,Osamu;Silva,Michael A.;Bhogal,Ricky H.;Croagh,Daniel;Cavallucci,David J.;Loveday,Benjamin Pt;Dunne,Declan Fj;Aroori,Somaiah;Davidson,Brian R.;Roberts,Keith J.;PVR audit collaborators
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2025
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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 (P90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.
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Annals of Surgery