Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study

PVR audit collaborators

doi:10.1097/SLA.0000000000006954

Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study

PVR audit collaborators

Queen Elizabeth Hospital
Royal North Shore Hospital
Royal Stoke University Hospital
Royal Liverpool University Dental Hospital
University Medical Centre Schleswig-Holstein
Royal London Hospital
Innsbruck Medical University
Department of HPB Surgery, Belfast Health and Social Care Trust, Belfast, UK.
Royal Blackburn Teaching Hospital
Department of HPB Surgery, Bristol Royal Infirmary, Bristol, UK.
Addenbrooke's Hospital
Reina Sofia University Hospital
Duke University Medical Center
Department of HPB Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Acibadem University School of Medicine
Department of HPB Surgery, Manchester Royal Infirmary, Manchester, UK.
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Freeman Hospital
University Hospital of Oslo
University Hospital of Padova
Kepler University Hospital
Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria.
University Hospital Southampton NHS Foundation Trust
Morriston Hospital
Auckland City Hospital
The Canberra Hospital
Christchurch Hospital
Umeå University Hospital
Medical University of Vienna
Department of Surgery, Northern Health, Melbourne, Australia.
St George Hospital
St. Vincent's Hospital Sydney
North Shore Hospital
Oxford University Hospital
Royal Marsden Hospital
Department of Surgery, Monash Medical Centre, Melbourne, Australia.
The Wesley Hospital
Royal Melbourne Hospital
The Royal Free Hospital
University Hospitals Plymouth NHS Trust

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: Assess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).

BACKGROUND: Retrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.

METHODS: This multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.

RESULTS: Among 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).

CONCLUSIONS: VR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.

Original language	English
Journal	Annals of Surgery
DOIs	https://doi.org/10.1097/SLA.0000000000006954
Publication status	E-pub ahead of print - 25 Sept 2025
Externally published	Yes

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10.1097/SLA.0000000000006954

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@article{26d941d62b374a84a9c74ae31a846bf8,

title = "Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study",

abstract = "OBJECTIVE: Assess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).BACKGROUND: Retrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.METHODS: This multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.RESULTS: Among 972 patients who underwent PD/TP with VR, 259 (26.6\%) received inpatient therapeutic anticoagulation and 242 (25.0\%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1\%, 7.3\%, and 11.6\%, versus 1.0\%, 1.3\% and 2.6\% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).CONCLUSIONS: VR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.",

author = "\{PVR audit collaborators\} and Labib, \{Peter L\} and McKay, \{Siobhan C\} and Perrodin, \{St{\'e}phanie F\} and Louisa Bolm and Mownah, \{Omar A\} and Ruben Bellotti and Jane McClements and Asma Sultana and Skipworth, \{James Ra\} and Anita Balakrishnan and Manuel Dur{\'a}n and Dimitrios Moris and Milburn, \{James A\} and Kurtoğlu, \{G{\"o}kalp K\} and Carino, \{Nicola De'Liguori\} and Ismael Dom{\'i}nguez-Rosado and Sanjay Pandanaboyana and Jacob Ghotbi and Giovanni Marchegiani and Athwal, \{Tejinderjit S\} and Stefan St{\"a}ttner and Karavias, \{Dimitrios D\} and Bilal Al-Sarireh and Morris, \{Paul D\} and Saxon Connor and Asif Halimi and Carl-Stephan Leonhardt and Russell Hodgson and Samra, \{Jaswinder S\} and Anubhav Mittal and Fisher, \{Oliver M\} and Lim, \{Christopher Sh\} and Banting, \{Simon W\} and Jonathan Koea and Osamu Yoshino and Silva, \{Michael A\} and Bhogal, \{Ricky H\} and Daniel Croagh and Cavallucci, \{David J\} and Loveday, \{Benjamin Pt\} and Dunne, \{Declan Fj\} and Somaiah Aroori and Davidson, \{Brian R\} and Roberts, \{Keith J\}",

year = "2025",

month = sep,

day = "25",

doi = "10.1097/SLA.0000000000006954",

language = "English",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

}

TY - JOUR

T1 - Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection

T2 - An International Multicentre Cohort Study

AU - PVR audit collaborators

AU - Labib, Peter L

AU - McKay, Siobhan C

AU - Perrodin, Stéphanie F

AU - Bolm, Louisa

AU - Mownah, Omar A

AU - Bellotti, Ruben

AU - McClements, Jane

AU - Sultana, Asma

AU - Skipworth, James Ra

AU - Balakrishnan, Anita

AU - Durán, Manuel

AU - Moris, Dimitrios

AU - Milburn, James A

AU - Kurtoğlu, Gökalp K

AU - Carino, Nicola De'Liguori

AU - Domínguez-Rosado, Ismael

AU - Pandanaboyana, Sanjay

AU - Ghotbi, Jacob

AU - Marchegiani, Giovanni

AU - Athwal, Tejinderjit S

AU - Stättner, Stefan

AU - Karavias, Dimitrios D

AU - Al-Sarireh, Bilal

AU - Morris, Paul D

AU - Connor, Saxon

AU - Halimi, Asif

AU - Leonhardt, Carl-Stephan

AU - Hodgson, Russell

AU - Samra, Jaswinder S

AU - Mittal, Anubhav

AU - Fisher, Oliver M

AU - Lim, Christopher Sh

AU - Banting, Simon W

AU - Koea, Jonathan

AU - Yoshino, Osamu

AU - Silva, Michael A

AU - Bhogal, Ricky H

AU - Croagh, Daniel

AU - Cavallucci, David J

AU - Loveday, Benjamin Pt

AU - Dunne, Declan Fj

AU - Aroori, Somaiah

AU - Davidson, Brian R

AU - Roberts, Keith J

PY - 2025/9/25

Y1 - 2025/9/25

N2 - OBJECTIVE: Assess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).BACKGROUND: Retrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.METHODS: This multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.RESULTS: Among 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).CONCLUSIONS: VR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.

AB - OBJECTIVE: Assess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).BACKGROUND: Retrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.METHODS: This multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.RESULTS: Among 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).CONCLUSIONS: VR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.

U2 - 10.1097/SLA.0000000000006954

DO - 10.1097/SLA.0000000000006954

M3 - Article

C2 - 40996212

SN - 0003-4932

JO - Annals of Surgery

JF - Annals of Surgery

ER -

Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study

Abstract

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