Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.804
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) remain controversial.
The goal of the present review was to clarify the effect of ATT on bleeding complications or increased surgical blood loss in hepatectomy.
The objective of the current systematic review was to investigate the effect of ATT on thromboembolism and bleeding in hepatectomy.
Articles published between 2011 and 2020 were searched from Google Scholar and PubMed, and after careful reviewing of all studies, studies concerning ATT and hepatectomy 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.
Liver resection in chronically ATT-received patients can be performed safely without increase in the rate of bleeding complications, although the safety and efficacy of chemical thromboprophylaxis for VTE during liver resection is still controversial especially in Asian population.
Further investigation using reliable studies with good design must be requisite to establish definite protocol or guidelines.