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Original Article
 
The incidence of clinically significant venous thromboembolism in an Asian population after major hepatobiliary and pancreatic surgery
B.C. Toh1, T.C.Y. Pang1,3, W.W.L. Woon1,2, D.X.W. Yeo1, Y.Z. Lee1, S.P. Junnarkar1, J. K. Low1
1Hepatobiliary and Pancreatic (HPB) Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
2School of Medicine, National University of Singapore, Singapore.
3Sydney Medical School, University of Sydney, Australia.

Article ID: 100035IJHPDBT2015
doi:10.5348/ijhpd-2015-35-CR-10

Address correspondence to:
Dr Bin Chet Toh
Department of General Surgery
11 Jalan Tan Tock Seng
Singapore 308433
Phone: +65 6357 2637
Fax: +65 6357 7809

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How to cite this article
Toh BC, Pang TCY, Woon WWL, Yeo DXW, Lee YZ, Junnarkar SP, Low JK. The incidence of clinically significant venous thromboembolism in an Asian population after major hepatobiliary and pancreatic surgery. Int J Hepatobiliary Pancreat Dis 2015;5:61–66.


Abstract
Introduction: The incidence of venous thromboembolism (VTE) is not well defined in Asian population after major hepatobiliary and pancreatic (HPB) surgery. The use of pharmacological prophylaxis is debatable due to postoperative coagulopathy. Aim: To determine the incidence of clinically significant VTE events in Asian undergoing major HPB surgery.
Methods: A retrospective review of patients undergoing major HPB surgery between January 2010 to August 2013 at Tan Tock Seng Hospital, Singapore was conducted. Clinical notes and radiology reports were reviewed to screen for patients who developed VTE. A secondary end-point was 30-day and 90-day mortality.
Results: 224 patients had major HPB surgery with median age of 61 years and BMI of 22.3. 143 patients were male. Majority of the patients were Chinese and most underwent open hepatic surgery for malignancy. A few had a past history of VTE. No patient developed DVT, whilst a single patient was diagnosed with pulmonary embolus. There were two unexpected deaths within 90 days of surgery and neither appeared to be VTE-related. Statistical tests comparing our results with reported baseline VTE risk in literature and risk with chemoprophylaxis would suggest the low incidence found in this study was comparable to Western patients given chemoprophylaxis.
Conclusion: The risk of VTE appears low in Asian patients undergoing major HPB surgery. Hence, one must consider if the benefits of low molecular weight heparin does indeed outweigh the risks.

Keywords: Asian, Venous thromboembolism, Major Hepatobiliary Surgery, Incidence


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Author Contributions:
B.C. Toh – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
T.C.Y. Pang – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
W.W.L. Woon – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
D.X.W. Yeo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Y.Z. Lee – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
S.P. Junnarkar – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
J. K. Low – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 B.C. Toh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.