Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and often arises in the context of a chronic liver disease that impairs coagulative function. Surgical resection is the best option to cure HCC, however, surgery on cirrhotic liver may increase the risk of bleeding. Despite the clinical relevance of the matter, no guidelines are available on the administration of antithromboembolic prophylaxis in cirrhotic patients undergoing hepatic resection.
A research team from Italy have retrospectively addressed the issue of the real need for antithromboembolic prophylaxis in cirrhotic patients undergoing liver resection and proved that the risk of venous thromboembolism after hepatic resection in cirrhotic patients is low. Their study will be published on May 7, 2010 in the World Journal of Gastroenterology .
They found that the incidence of venous thrombosis after these procedures was low when no prophylaxis was adopted, while a trend towards an increased risk of bleeding was observed when low-molecular-weight heparin was administered. In particular, the presence of esophageal varices may contraindicate prophylaxis as it is associated with postoperative hemorrhage.
Prospective studies on a larger series of patients are warranted to clearly define which patients might benefit from antithromboembolic prophylaxis and which patients should avoid prophylaxis.
Reference: Vivarelli M, Zanello M, Zanfi C, Cucchetti A, Ravaioli M, Del Gaudio M, Cescon M, Lauro A, Montanari E, Grazi GL, Pinna AD. Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: Is it necessary? World J Gastroenterol 2010; 16(17): 2146-2150
Correspondence to: Dr. Marco Vivarelli, Department of Surgery and Transplantation, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy. firstname.lastname@example.org
Telephone: +39-51-6363721 Fax: +39-51-397661
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.