Pre- vs Postoperative Thromboprophylaxis for Liver Resection
Status:
Recruiting
Trial end date:
2025-03-01
Target enrollment:
Participant gender:
Summary
Thromboprophylaxis for liver surgery can be commenced either preoperatively or
postoperatively. Despite a clear trade-off between thrombosis and bleeding in liver surgery
patients, there is no international consensus when thrombosis prophylaxis should be commenced
in patients undergoing liver surgery. As far as we know, there are no prospective randomized
trials in this field, and current guidelines are unfortunately based on very low quality
evidence, that is, a few retrospective studies and expert opinion. Both American and European
thromboprophylaxis guidelines for abdominal cancer surgery support the preoperative
initiation of thromboprophylaxis, but these guidelines do not specifically address the
increased bleeding risk associated with liver surgery. On the contrary, Dutch guidelines
recommend postoperative thromboprophylaxis only, because of lack of evidence for preoperative
thromboprophylaxis. Traditionally, many liver surgery units have been reluctant in using
preoperative thromboprophylaxis due to the potentially increased risk of bleeding
complications. Enhanced Recovery After Surgery (ERAS) Society Guidelines recommend
preoperative thromboprophylaxis in liver surgery, but the guidelines provide no supporting
evidence for this recommendation. Overall, the amount of evidence is scarce and somewhat
contradictory in this clinically relevant field of thromboprophylaxis in liver surgery. The
aim of this study is to compare pre- and postoperatively initiated thromboprophylaxis
regimens in liver surgery in a randomized controlled trial.
Phase:
Phase 4
Details
Lead Sponsor:
Helsinki University Central Hospital
Collaborators:
Academy of Finland The Finnish Medical Association