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Background: Pancreaticoduodenectomy (PD) is a lengthy surgical procedure often done for malignancy, both risk factors for DVT/PE, which also carries a significant bleeding risk. We sought to determine if bleeding complications were increased with pre-operatively administered Lovenox, a drug given once daily and shown to have excellent DVT/PE risk reduction, compared with pre-operative Heparin.
Methods: IRB approved retrospective chart review was undertaken to collect data on all patients undergoing PD from 1/1/08-12/31/11. Data points included demographic information, surgical details, and peri-operative outcomes, focusing on estimated blood loss (EBL) and blood usage. DVT/PE prophylaxis consisted of either 5,000units subcutaneous Heparin or 40mg subcutaneous Lovenox given pre-operatively.
Results: The 158 patients undergoing PD had a mean age of 65 (range 40-85), 52% were men, and 11% received neoadjuvant treatment. 21.5% of the cases included major vascular resection, and average BMI was 27.5 (15.2-47). 52% (82) of the patients had pancreatic adenocarcinoma, 5% (8) duodenal adenocarcinoma, and 7% (11) IPMN. There was no difference in mean EBL between the 92 patients receiving pre-op Heparin (731+525ml) and the 35 patients receiving pre-op Lovenox (794+634ml, p=0.58). Bleeding complications and overall blood usage were also not significantly different between the 2 groups (p>0.05).
Conclusions: Pre-operatively administered Lovenox was not associated with an increase in EBL during PD compared with Heparin. Overall blood usage was also not increased. This, along with once daily dosing and improved efficacy make Lovenox and attractive option for DVT/PE prophylaxis during PD.