Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2021; 13(7): 804-814
Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.804
Safety of liver resection in patients receiving antithrombotic therapy: A systematic review of the literature
Takahisa Fujikawa
Takahisa Fujikawa, Department of Surgery, Kokura Memorial Hospital, Fukuoka 802-8555, Japan
Author contributions: Fujikawa T designed and performed research, and analyzed data; Fujikawa T prepared a manuscript and reviewed it.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Takahisa Fujikawa, FACS, MD, PhD, Chief Doctor, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kitakyushu, Fukuoka 802-8555, Japan.
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: May 2, 2021
Revised: May 7, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: July 27, 2021

Little is unknown about the effect of chronic antithrombotic therapy (ATT) on bleeding complication during or after hepatectomy. In addition, the safety and effectiveness of chemical prevention for venous thromboembolism (VTE) is still controversial.


To clarify the effect of ATT on thromboembolism and bleeding after liver resection.


Articles published between 2011 and 2020 were searched from Google Scholar and PubMed, and after careful reviewing of all studies, studies concerning ATT and liver resection were included. Data such as study design, type of surgery, type of antithrombotic agents, and surgical outcome were extracted from the studies.


Sixteen published articles, including a total of 8300 patients who underwent hepatectomy, were eligible for inclusion in the current review. All studies regarding patients undergoing chronic ATT showed that hepatectomy can be performed safely, and three studies have also shown the safety and efficacy of preoperative continuation of aspirin. Regarding chemical prevention for VTE, some studies have shown a potentially high risk of bleeding complications in patients undergoing chemical thromboprophylaxis; however, its efficacy against VTE has not been shown statistically, especially among Asian patients.


Hepatectomy in patients with chronic ATT can be performed safely without increasing the incidence of bleeding complications, but the safety and effectiveness of chemical thromboprophylaxis against VTE during liver resection is still controversial, especially in the Asian population. Establishing a clear protocol or guideline requires further research using reliable studies with good design.

Keywords: Liver resection, Bleeding complication, Antithrombotic therapy, Thromboembolic complication, Thromboprophylaxis

Core Tip: A total of 16 published articles on antithrombotic therapy and hepatectomy have been reviewed systematically. The articles showed that the risk of thromboembolic and/or bleeding events in patients with continued preoperative aspirin was not different from those in patients with no antithrombotic or interrupted antiplatelet drugs, although pharmacological prophylaxis of venous thromboembolism is still controversial, especially when performing hepatectomy in Asian patient populations.