Liver Injury Among Japanese Patients Treated Using Prophylactic Enoxaparin After Colorectal Surgery
Liver Injury Among Japanese Patients Treated Using Prophylactic Enoxaparin After Colorectal Surgery
复制标题
DOI：
10.1007/s10620-020-06586-8
复制
发表时间：
2020-09-05
影响因子：
3.1
通讯作者：
Ishihara, Soichiro
中科院分区：
文献类型：
--
作者：
Nozawa, Hiroaki;Emoto, Shigenobu;Ishihara, Soichiro
依诺肝素是一种低分子量肝素，已被用于预防大手术中的血栓形成事件，而不会增加出血率。另一方面，据报告可导致肝损伤，但腹部手术后预防性依诺肝素诱导肝损伤的详细情况尚不清楚。目的本研究旨在阐明结直肠手术后预防性依诺肝素与肝损伤的关系，并描述损伤特征。方法我们回顾性分析了732例接受选择性结直肠切除术的日本患者，并根据预防性使用依诺肝素的情况，比较其临床病理背景、手术细节、术后并发症（包括肝损伤）和肝损伤类型。进行单因素和多因素分析，以确定术后肝损伤的危险因素。结果结直肠癌术后预防性应用依诺肝素的患者肝损伤发生率为8.9%，而未应用依诺肝素的患者肝损伤发生率为1.4%（P < 0.0001）。在接受依诺肝素治疗的患者中，肝损伤的中位发病时间为7天，大多数表现为肝细胞型。多因素分析显示，依诺肝素是术后肝损伤的独立危险因素之一（OR：7.63，P < 0.0001）。结论预防性使用依诺肝素可明显增加结直肠手术患者术后肝损伤的发生率。我们的研究证实，密切监测肝功能参数对术后接受依诺肝素治疗的患者至关重要。
Background Enoxaparin, a low molecular weight heparin, has been used to prevent thrombotic events during major surgery without increasing the rate of hemorrhage. On the other hand, it was reported to cause liver injury, but the details of liver injury induced by prophylactic enoxaparin after abdominal surgery remain unclear. Aims This study aimed to clarify the relationship between prophylactic enoxaparin and liver injury after colorectal surgery, and characterize the injury profile. Methods We retrospectively reviewed 732 Japanese patients who underwent elective resection of the colorectum, and compared their clinicopathological background, details of surgery, postoperative complications, including liver injury, and the type of liver injury according to prophylactic use of enoxaparin. Univariate and multivariate analyses were performed to identify risk factors for liver injury during the postoperative period. Results The rate of liver injury was 8.9% for patients treated by prophylactic enoxaparin and 1.4% for those who did not receive enoxaparin after colorectal surgery (p < 0.0001). The median onset of liver injury among patients receiving enoxaparin was seven days, and the majority demonstrated the hepatocellular pattern. Enoxaparin was one of the independent risk factors for postoperative liver injury by multivariate analysis (odds ratio: 7.63,p < 0.0001). Conclusions Prophylactic use of enoxaparin markedly increased the rate of postoperative liver injury in patients who underwent colorectal surgery. Our study confirmed that close monitoring of liver function parameters is essential for patients receiving enoxaparin during the postoperative period.