423 Anticoagulation and Antiplatelet Strategies After Venous Resection During Pancreatectomy: A Systematic Review

Abstract Aim To evaluate thrombosis and bleeding outcomes associated with anticoagulation (AC) and/or antiplatelet (AP) strategies following portal or superior mesenteric vein resection during pancreatectomy. Method A systematic search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science was conducted up to May 2025, following PRISMA guidelines. Studies reporting postoperative AC/AP use and outcomes after pancreatectomy with venous resection were included. Data were extracted on prophylaxis regimen, reconstruction type, thrombosis, and bleeding. Studies were stratified into five groups: AC-only, AP-only, AC+AP, mixed, or no prophylaxis. Due to heterogeneity, a descriptive synthesis was performed. Group comparisons were assessed using chi-square tests. Results Sixty studies comprising 4,664 patients were included. Median thrombosis rates were lowest in the AP-only group (2.3%) and highest in the AC+AP group (15.4%, p < 0.001). AC-only strategies showed a moderate thrombosis rate (9.6%). Bleeding complications were low (range 3.5–6.1%) across all groups, with no significant difference (p = 0.18). Higher thrombosis rates were consistently seen in patients undergoing segmental venous resection with interposition grafts, especially synthetic or allogeneic. In contrast, primary suture or patch repairs were associated with lower thrombosis risk. The elevated thrombosis in the AC+AP-group likely reflects its selective use in complex reconstructions and high-risk patients, along with intensified surveillance detecting more symptomatic and asymptomatic thromboses. Variability in surveillance protocols and outcome definitions limited direct comparisons. Conclusions No strategy proved clearly superior. Prophylaxis should be tailored to resection strategy, reconstruction type, and individual risk. Standardized definitions and prospective studies are needed to guide evidence-based practice.