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

作     者：Takahisa Fujikawa Shigetoshi Naito 

作者机构：Department of SurgeryKokura Memorial HospitalKitakyushu 802-8555Japan 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2021年第9卷第23期

页      面：6747-6758页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Antithrombotic therapy Pancreatic surgery Perioperative management Antiplatelet therapy Anticoagulation therapy Pancreaticoduodenectomy 

摘      要：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 *** safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains *** To elucidate the effect of ATT on *** 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 *** such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the *** Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic *** were cohort studies,with only three being prospective in *** 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 *** remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin *** 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 *** 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 *** investigation using reliable studies with good design is required to establish definite pr