Rate of prophylactic anti-Xa achievement and impact on venous thromboembolism following oncologic hepato-pancreatico-biliary surgery: A prospective cohort study

• Published in: The American journal of surgery 2023-06, Vol.225 (6), p.1022-1028
• Main Authors: Verhoeff, Kevin, Connell, Matthew, Shapiro, AM James, Strickland, Matt, Bigam, David L., Anantha, Ram V.
• Format: Article
• Language: English
• Subjects: Adult; anti-Xa; Anticoagulants - therapeutic use; Bleeding; Chronic obstructive pulmonary disease; Cohort analysis; Complications; Compression therapy; Demographics; Drug dosages; Enoxaparin - therapeutic use; Female; Gastroesophageal reflux; Guidelines; Hemorrhage - complications; Heparin, Low-Molecular-Weight - therapeutic use; Hepatobiliary; Hospitals; HPB oncology; Humans; LMWH; Oncology; Patients; Prophylaxis; Prospective Studies; Regression analysis; Risk assessment; Statistical analysis; Surgeons; Surgery; Thromboembolism; Thrombosis; Variables; Venous thromboembolism; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.12.001

Hepato-pancreatico-biliary (HPB) patients experience competing risk of venous thromboembolism (VTE) and bleeding. We sought to evaluate the effect of anti-Xa levels on VTE and bleeding, and to characterize factors associated with subprophylaxis. This prospective cohort study evaluated adult HPB surgical patients; cohorts were described by anti-Xa levels as subprophylactic (0.5 IU/mL). Primary outcome evaluated bleeding and VTE complications. Secondary outcomes evaluated factors associated with subprophylaxis. We included 157 patients: 68 (43.6%) attained prophylactic anti-Xa and 89 (56.7%) were subprophylactic. Subprophylactic patients experienced more VTE compared to prophylactic patients (6.9% vs 0%; p = 0.028) without differences in bleeding complications (14.6% vs 5.9%; p = 0.081). Factors associated with subprophylactic anti-Xa included female sex (OR 2.90, p = 0.008), and Caprini score (OR 1.30, p = 0.035). Enoxaparin was protective against subprophylaxis compared to tinzaparin (OR 0.43, p = 0.029). Many HPB patients have subprophylactic anti-Xa levels, placing them at risk of VTE. Enoxaparin may be preferential, however, studies evaluating optimized prophylaxis are needed. [Display omitted] •Current LMWH regimens place HPB patients at risk of subprophylactic Anti-Xa levels.•Subprophylactic anti-Xa levels are associated with increased risk of VTE.•In HPB patients, tinzaparin has increased rate of subprophylactic anti-Xa levels.