Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2021; 9(23): 6747-6758
Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6747
Safety of pancreatic surgery with special reference to antithrombotic therapy: A systematic review of the literature
Takahisa Fujikawa, Shigetoshi Naito
Takahisa Fujikawa, Shigetoshi Naito, Department of Surgery, Kokura Memorial Hospital, Kitakyushu 802-8555, Japan
Author contributions: Fujikawa T designed and performed research, and analyzed data; Naito S also performed research; Fujikawa T prepared a manuscript and reviewed it.
Conflict-of-interest statement: The authors declare no relevant conflicts of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takahisa Fujikawa, FACS, MD, PhD, Chief Doctor, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-8555, Japan. fujikawa-t@kokurakinen.or.jp
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: April 5, 2021
Revised: April 27, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 16, 2021
Processing time: 188 Days and 10.3 Hours
Abstract
BACKGROUND

Postpancreatectomy hemorrhage (PPH) is the most severe type of complication after pancreatic surgery, although the effect of antithrombotic therapy (ATT) on PPH is largely unknown. The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism (VTE) remains controversial.

AIM

To elucidate the effect of ATT on PPH.

METHODS

Published articles between 2013 and 2020 were searched from PubMed and Google Scholar, and after careful reviewing of all studies, studies concerning ATT and pancreatic surgery were included. Data such as study design, type of surgical procedures, type of antithrombotic drugs, and surgical outcome were extracted from the studies.

RESULTS

Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review. Fourteen were cohort studies, with only three being prospective in nature. Two studies demonstrated that in patients receiving chronic ATT, which were mostly managed by heparin bridging, the risk of PPH was higher compared with those without ATT, and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others. The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT, even under preoperative aspirin continuation. Concerning chemical thromboprophylaxis for VTE, most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis; however, its effectiveness against VTE has not been statistically demonstrated, particularly among Asian patients.

CONCLUSION

Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH, although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial. Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.

Keywords: Antithrombotic therapy; Pancreatic surgery; Perioperative management; Antiplatelet therapy; Anticoagulation therapy; Pancreaticoduodenectomy

Core Tip: A total of 19 published articles on antithrombotic therapy and pancreatic surgery have been reviewed systematically. The articles showed that the risk of perioperative thromboembolic and/or bleeding complications in patients with heparin bridging or continued antiplatelets was not significantly higher than in patients with no antithrombotic or interrupted antiplatelets, although medical thromboprophylaxis for venous thromboembolism remains controversial when performing pancreatectomy for malignancy.