Systematic Reviews
Copyright ©The Author(s) 2021.
World J Hepatol. Jul 27, 2021; 13(7): 804-814
Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.804
Table 1 Types, specific agents, and acting duration of commonly used antithrombotic drugs
Class of agents
Type
Specific agents
Duration of action
Antiplatelets
ThienopyridinesClopidogrel (Plavix), ticlopidine (Panardine), prasugrel (Effient), ticagrelor (Brilinta)5-7 d1
Type III PDE inhibitorCilostazol (Pretal)2 d
Acetylsalicylic acidAspirin7-10 d
Other NSAIDsIbuprofen (Brufen, Advil), loxoprofen (Loxonin), diclofenac (Voltaren) etc.Varies
Anticoagulants
Heparin (unfractionated)Heparin1-2 h
Heparin (LMWH)Dalteparin (Fragmin iv), enoxaparin (Clexane, s.c.), nadroparin (s.c.)6-12 h2
Vitamin K antagonistWarfarin (Coumadin)5 d
Factor Xa inhibitor (s.c.)Fondaparinux (Arixtra)1-1.5 d
DOACs
Direct thrombin inhibitorDabigatran (Pradaxa)1-2 d
Factor Xa inhibitorsRivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana)1-2 d
Table 2 Reported data concerning bleeding complications of liver resection in patients with antithrombotic therapy
Ref.
Year, type
Surgery type
Drug use and exposure
Bleeding events
TE, mortality
Naito et al[9]2020, PSMLiver resection (n = 425)Patients with continued ASA (n = 63); Patients not on continued APT (control, n = 362); Post-PSM: 63 vs 63 matched casesBC 4.8% in continued ASA vs 4.8% in control (P = 1.00); SBL was identical (P = 0.54)TE 1.6% in continued ASA vs 4.8% in control (P = 0.62); Mortality 1.6% vs 1.6% (P = 1.00)
Fujikawa et al[10]2017, RCSLiver resection (n = 258) including 77 laparoscopic liver resectionPatients with ATT (n = 100); Patients without ATT (control; n = 158)BC 3.0% in ATT vs 3.8% in control (P > 0.05); No BC in laparoscopic surgery; SBL was identicalTE 1.0% vs 1.3% (P > 0.05); No TE in laparoscopic surgery; Mortality 1.0% vs 0% (P = 0.350)
Ishida et al[11]2017, CCSHBP surgery (n = 886) including 520 liver resectionPatients with ACT (n = 39); Patients with APT (n = 77); Patients without ATT (control, n = 770)BC 0.0% in ACT vs 1.3% in APT vs 3.4% in control (P = 0.32); SBL was identical (P = 0.99)TE 0% vs 1.3% vs 0.8% (P = 0.75); Mortality 0% vs 0% vs 1.2% (P = 0.50)
Gelli et al[12]2018, PSMLiver resection (n = 1803)Patients with continued ASA (n = 118); Patients not on continued APT (control, n = 1685); Post-PSM: 108 vs 108 matched casesOverall BC 10.2% in continued ASA vs 12.0% in control (P > 0.05); Major BC 6.5% vs 5.6% (P > 0.05)Mortality 5.6% vs 4.6% (P > 0.05)
Monden et al[13]2017, CCSLiver resection (n = 378)Patients with continued ASA (n = 31); Patients not on continued APT (control, n = 347)Major BC 0% in continued ASA vs 0.3% in control (P > 0.05); SBL 450 mL vs 360 mL (P = 0.735)TE 3.2% vs 0% (P > 0.05); Mortality 3.2% vs 0.9% (P = 0.291)
Fujikawa et al[14]2019, CCSHBP surgery (n = 105) including 37 liver resectionPatients with DOAC (n = 35); Patients with WF (control, n = 80)BC 2.9% in DOAC vs 0% in WF (P = 0.304); SBL was identical (P = 0.782)No TE event in both groups; No mortality in both groups
Table 3 Reported data concerning the safety of thromboprophylaxis for venous thromboembolism during liver resection
Ref.
Year, type
Surgery type
Drug use and exposure
Bleeding events
TE, mortality
Ainoa et al[15]2020, RCSLiver resection (n = 512)Patients with preop TP (n = 253); Patients with postop TP (control, n = 259)BC 15.0% in preop TP vs 13.9% in control (P > 0.05)VTE 1.2% vs 9.7% (P < 0.0001); PE 1.2% vs 9.3% (P < 0.0001)
Ejaz et al[16]2014, RCSLiver resection (n = 599)Patients with TP (n = 454); Patients without TP (control, n = 145)Not mentionedVTE 5.1% in TP vs 3.4% in control (P = 0.42)
Nathan et al[17]2014, RCSLiver resection (n = 2147)Patients with early TP (n = 1295); Patients with late or no TP (control, n = 852)Major BC 1.7% in early TP vs 1.6% in control (P > 0.05)VTE 2.1% vs 3.3% (P > 0.05); Overall mortality 1.9%
Eguchi et al[18]2020, mPCSMajor HBP surgery (n = 133) including 74 liver resectionPatients with TP [LMWH (enoxaparin), n = 133, single arm]Major BC 2.3%; Minor BC 5.2%No PE event in whole cohort
Hayashi et al[19]2014, RCSMajor HBP surgery (n = 349) including 138 liver resectionPatients 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 identicalVTE 2.9% vs 7.7% (P > 0.05)
Wang et al[20]2018, CCSLiver resection (n = 233)Patients with TP (LMWH, n = 117); Patients without TP (control, n = 116)Not mentionedVTE 0.85% in TP vs 13.8% (P < 0.05)
Kim et al[21]2017, RCSLiver resection (n = 124)Patients with extended TP [LMWH (enoxaparin), n = 124, single arm]BC 1.6% in extended TPNo VTE in whole cohort
Doughtie et al[22]2014, RCSMajor HBP surgery (n = 223) including 110 liver resectionPatients 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 identicalVTE 1.1% vs 6.1% (P = 0.05)
Melloul et al[23]2012, RCSLiver resection (n = 410)Patients with TP (n = 410, single arm)Not mentionedPE 6% (24/410) in TP
Reddy et al[24]2011, RCSMajor liver resection (n = 419)Patients with TP (n = 275); Patients without TP (control, n = 144)RBC transfusion rate 35.0% in TP vs 30.6% in control (P = 0.36)CR-VTE 2.2% in TP vs 6.3% in control (P = 0.03); PE 2.2% vs 4.2% (P = 0.35)