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Research Article
Antiplatelet therapy after pancreaticoduodenectomy with portal vein resection as the optimal preventative strategy for maintaining primary vein patency
1 Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
2 Resident, Division of Hepatopancreatobiliary Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
3 Attending Surgeon, Division of Hepatopancreatobiliary Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
Address correspondence to:
Dionisios Vrochides
MD, PhD, FACS, FRCSC, Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC 28203,
USA
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Article ID: 100096Z04MA2021
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Anderson MK, Pickens RC, Davis J, Baker EH, Martinie JB, Iannitti DA, Vrochides D. Antiplatelet therapy after pancreaticoduodenectomy with portal vein resection as the optimal preventative strategy for maintaining primary vein patency. Int J Hepatobiliary Pancreat Dis 2021;11:100096Z04MA2021.ABSTRACT
Aim: Anticoagulation after pancreaticoduodenectomy with portal vein resection is relevant to maintaining vein patency; however, no uniformly accepted algorithm exists for anticoagulant selection. We evaluated patients undergoing pancreaticoduodenectomy with various degrees of portal venous resection and reconstruction to determine the optimal regimen for anticoagulation therapy.
Methods: A retrospective review of 51 patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy with venous resection was performed (2006 through 2016). Venous resections were categorized as tangential, segmental with primary anastomosis, or segmental with vein graft. Type of anticoagulation selected by the surgeon was noted. The primary outcome was vein patency measured through the first year postoperatively.
Results: Of 33 patients eligible for study, 7 underwent tangential resection, 16 underwent segmental resection, and 10 underwent vein graft. Vein patency rates at 2, 4, 6, and 11 months were 96.9%, 93.1%, 89.3%, and 62.5%, respectively. All patients with tangential resection showed patency at six months, regardless of the use of anticoagulation or not. For segmental resection, patency was higher with antiplatelet/warfarin (62.5%) compared with no treatment (25%). For segmental resection with vein graft, patency at 10 months was higher with antiplatelet therapy (80%) compared with warfarin (33%).
Conclusion: For patients undergoing pancreaticoduodenectomy with portal vein resection, anticoagulation therapy may be guided by the degree of resection and reconstruction required. Although anticoagulation therapy may be unnecessary with tangential vein resection, anticoagulation in the form of antiplatelet therapy may be preferable in patients who have segmental vein resections with primary anastomoses and vein grafts.
Keywords: Anticoagulation, Pancreatic adenocarcinoma, Portal vein resection, Whipple
SUPPORTING INFORMATION
Author Contributions
Meshka K Anderson - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ryan C Pickens - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Joshua Davis - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Erin H Baker - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
John B Martinie - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
David A Iannitti - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Dionisios Vrochides - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Meshka K Anderson 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.
