Safety of Single Preoperative Dose of Enoxaparin for Hepatectomy: A Study in a Country With Low Venous Thromboembolism Incidence.

Background: Postoperative venous thromboembolism (VTE) prophylaxis for hepatectomy is debated in low-VTE incidence regions like Thailand due to bleeding risks. This study evaluated single-dose preoperative enoxaparin safety for VTE prophylaxis, focusing on post-hepatectomy hemorrhage (PHH).

Methods: This retrospective review compared VTE and PHH incidence before (no prophylaxis) and after implementation of a single preoperative dose of enoxaparin 40 mg for all patients undergoing elective hepatectomy in a center in Thailand. PHH and post-hepatectomy liver failure (PHLF) were defined per International Study Group of Liver Surgery criteria. Factors associated with PHH were analyzed using logistic regression.

Results: One hundred eighty-six patients underwent elective hepatectomy (mean age 58 years). Fifty-two percent underwent major hepatectomy. PHLF occurred in 11% of patients. VTE occurred in 0% (0/96) of the pre-protocol and 1.1% (1/90) of the post-protocol group. PHH rate was 3.8%, with no difference between pre-protocol (3/96) and post-protocol groups (4/90). Factors associated with PHH were intraoperative transfusion > 2 units (OR 33.3; 95% CI 1.9-587.7) and PHLF (OR 17.2; 95% CI 2.1-140.8), but not enoxaparin (OR 1.9; 95% CI 0.3-12.8).

Conclusions: Single preoperative enoxaparin did not increase PHH risk in this low VTE incidence cohort and may be considered for VTE prophylaxis in similar populations.