Enoxaparin attenuates early postoperative elevation of D-dimer following hepatobiliary and pancreatic surgery

Abstract Purpose We previously reported the safety and efficacy of postoperative enoxaparin administration for venous thromboembolism prophylaxis after hepatobiliary and pancreatic (HBP) surgery in the multicenter, randomized, controlled phase II CSGO-HBP-013 trial. Here, we report a post hoc analysis investigating the effect of postoperative enoxaparin administration on changes in coagulation markers after HBP surgery. Methods We analyzed data from the CSGO-HBP-013 trial. Patients were allocated in a 1:1 ratio to the control or enoxaparin group, and analyses were performed in the as-treated population. Platelet count, prothrombin time, activated partial thromboplastin time, and D-dimer levels were evaluated preoperatively and on postoperative days (POD) 1, 3, 5, and 7. Results We analyzed 127 patients in the control group and 117 in the enoxaparin group. Postoperative platelet count, prothrombin time, and activated partial thromboplastin time did not differ significantly between the two groups at any time point after surgery. In contrast, the postoperative elevation of D-dimer was attenuated in the enoxaparin group, with a significant difference on POD 3 (5.54 vs. 4.31 µg/mL, p = 0.027) and a trend toward lower levels on POD 5 (11.6 vs. 7.95 µg/mL, p = 0.067). In subgroup analyses, this attenuation was most pronounced in patients who underwent anatomical hepatectomy ( n = 84, POD 3: 7.71 vs. 4.93 µg/mL, p = 0.038). Conclusion Postoperative enoxaparin administration attenuates early D-dimer elevation after HBP surgery. This effect was particularly evident in anatomical hepatectomy, suggesting that enoxaparin might have a preferential attenuating effect on postoperative hypercoagulability in this subgroup.