Pre- vs. Postoperative Thromboprophylaxis in Pancreatic Surgery
Status:
Not yet recruiting
Trial end date:
2026-03-01
Target enrollment:
Participant gender:
Summary
Thromboprophylaxis for pancreatic surgery can be commenced either preoperatively or
postoperatively. Despite a clear trade-off between thrombosis and bleeding in pancreatic
surgery patients, there is no international consensus when thrombosis prophylaxis should be
commenced in patients undergoing pancreatic surgery. There are no prospective randomized
trials in this field, and current guidelines are unfortunately based on very low quality
evidence, that is, a few retrospective studies and expert opinion. Both American and European
thromboprophylaxis guidelines for abdominal cancer surgery support the preoperative
initiation of thromboprophylaxis, but these guidelines do not specifically address the
increased bleeding risk associated with pancreatic surgery. On the contrary, Dutch guidelines
recommend postoperative thromboprophylaxis only, because of lack of evidence for preoperative
thromboprophylaxis. Enhanced Recovery After Surgery (ERAS) Society Guidelines recommend
preoperative thromboprophylaxis in pancreatic surgery, but the guidelines provide no
supporting evidence for this recommendation. Overall, the amount of evidence is scarce and
somewhat contradictory in this clinically relevant field of thromboprophylaxis in pancreatic
surgery. The aim of this study is to compare pre- and postoperatively initiated
thromboprophylaxis regimens in pancreatic surgery in a randomized controlled trial.