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Pulmonary embolism after elective liver resection: A prospective analysis of risk factors.
MedLine Citation:
PMID:  22889956     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Impairment of clotting factors after liver resection (LR) is considered to protect from the risk of pulmonary embolism (PE). We aimed to formally investigate the risk of PE after elective LR. METHODS: From 2007 to 2009, 410 consecutive patients were prospectively analyzed to assess the risk of postoperative PE after LR with a thoracic CT scan, with or without a CT Pulmonary Angiography (CTPA). All patients were on a standardized thromboprophylaxis regimen. RESULTS: PE was diagnosed in 24 (6%) patients within the first 10 postoperative days. Comparison between PE group (n=24) and non-PE group (n=386) showed a similar rate of metastatic liver disease (25 vs. 31%, p=0.308) but higher rates of BMI ⩾25 kg/m(2) (75 vs. 46%, p=0.006), major LR (79 vs. 45%, p=0.003) and normal or minimally fibrotic liver parenchyma (92 vs. 73%, p=0.05). No patients with PE had inherited or acquired coagulation disorders. The 90-day mortality rate was similar in the two groups (4% vs. 3%, p=0.77) but median hospital stay was longer in the PE group (20(IQR 16-27) vs. 11(IQR 8-16) days, p=0.001). On multivariate analysis, the independent predictors for PE were a BMI ⩾25 kg/m(2) (adj. OR 5.27), major LR (adj. OR 3.13) and normal or minimally fibrotic liver parenchyma (adj. OR 4.21). CONCLUSION: In addition to patients' characteristics (high BMI), major resection and normal liver parenchyma increase the risk of PE after LR. This suggests that specific thromboembolic mechanisms are involved during liver regeneration and advocates more aggressive thromboprophylaxis in the high-risk groups.
Authors:
Emmanuel Melloul; Fédérica Dondéro; Valérie Vilgrain; Dimitri A Raptis; Catherine Paugam-Burtz; Jacques Belghiti
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-10
Journal Detail:
Title:  Journal of hepatology     Volume:  -     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
Affiliation:
Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Hospital Beaujon, University Paris 7, Clichy-France.
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