Safety of pancreatic surgery with special reference to antithrombotic therapy: A systematic review of the literature

Table 3 Reported data concerning the safety of thromboprophylaxis for venous thromboembolism during pancreatic surgery

Ref.	Year, Type	Surgery type	Drug use and exposure	Bleeding events	TE, mortality
Eguchi et al[25]	2020 PCS	Major HBP surgery including pancreatic surgery	Patients with TP [LMWH (enoxaparin), n = 133, single arm]	Major BC 2.3%; Minor BC 5.2%	No TE event in whole cohort
Hashimoto et al[26]	2017 PCS	Pancreatic surgery	Patients with TP [LMWH (enoxaparin), n = 103, single arm]	Major PPH 2.9%	Asymptomatic VTE 1.9%; No symptomatic VTE; No motality
Imamura et al[27]	2017 PCS	Pancreatic surgery	Patients with TP [LMWH (enoxaparin), n = 151, single arm]	Major PPH 3.3%; Minor PPH 3.3%	No PE event in whole cohort
Hanna-Sawires et al[28]	2019 RCS	Pancreatic surgery	Patients with single LMWH (nadroparin) (n = 80); Patients with double dose LMWH (n = 80); Patients with split dose LMWH (n = 80)	CR-PPH 16.0% in double LMWH vs 3.8% in others (P = 0.015)	VTE was identical among groups
Fong et al[29]	2020 RCS	Pancreatic surgery	Patients with TP (preop heparin, n = 1062); Patients without TP (control, n = 386)	(Not mentioned)	VTE 2.6% in TP vs 1.3% in control (P = 0.079), increased AOR in TP (AOR 2.93, P = 0.031)
Doughtie et al[30]	2014 RCS	Major HBP surgery including pancreatic surgery	Patients with preop TP (LMWH, n = 93); Patients without preop TP (control, n = 130)	Major BC 10.9% in preop TP vs 3.1% in control (P = 0.026); SBL was identical	VTE 1.1% vs 6.1% (P = 0.05)
Hayashi et al[31]	2014 RCS	Major HBP surgery including 211 pancreatic surgery	Patients with TP (n = 207); Patients without TP (control, n = 142)	BC 26.6% in TP vs 8.5% in control (P < 0.05); Rate of major BC is identical	VTE 2.9% vs 7.7% (P < 0.05)
Skertich et al[32]	2019 RCS	Surgery for NETs including pancreatic surgery	Patients with abdominal NETs (n = 7226, single arm)	(not mentioned)	VTE 2.0% in whole cohort; VTE 3.4% in malignant PNETs
Rashid et al[33]	2019 RCS	Pancreatic surgery for malignant diseases	Patients with extended DOAC [dabigatran] until POD28 (n = 134, single arm)	Major PPH 2.0% and minor PPH 2.0%	Post-discharge VTE 2.0%
Beal et al[34]	2018 RCS	Major HBP surgery including pancreatic surgery	Patients with hepatectomy or pancreatectomy (n = 48860, single arm)	(not mentioned)	VTE 3.2% after hepatectomy; VTE 1.1% after pancreatectomy; Post-discharge VTE 1.1% in all

PCS: Prospective cohort study; RCS: Retrospective cohort study; TP: Thromboprophylaxis; LMWH: Low-molecular-weight heparin; NET: Neuroendocrine tumor; DOAC: Direct-acting oral anticoagulant; PPH: Postpancreatectomy hemorrhage; CR: Clinically relevant; SBL: Surgical blood loss; BC: Postoperative bleeding complication; VTE: Venous thromboembolism; PE: Pulmonary embolism; AOR: Adjusted odds ratio; PNET: Pancreatic NET.