BACKGROUND: Liver resection increases venous thromboembolism (VTE) risk due to malignancy-related hyper-coagulopathy and surgical inflammation. Current guidelines recommend early post-operative and extended pharmacologic prophylaxis for all patients but lack stratification by patient or surgical factors. Despite these guidelines, surgeon preferences influence prophylaxis practices. This study aimed to identify clinical factors associated with VTE following liver resection.

METHODS: Using data from the Hemorrhage During Liver Resection (HeLiX) trial, a randomized clinical trial of patients undergoing liver resection for cancer, univariate comparisons and logistic regression were performed.

RESULTS: Study cohort VTE incidence was 4.1 %. Multivariable analysis identified major liver resection (odds ratio (OR) 2.59, 95 % confidence interval (CI) 1.38-5.03) and higher estimated blood loss (EBL) (OR 1.14 per 500 mL increase, 95 % CI 1.03-1.26) as associated with increased risk. Surgical duration (OR 1.14 per hour increase, 95 % CI 0.95-1.34) and use of tranexamic acid (OR 1.77, 95 % CI 0.98-3.27) did not reach statistical significance. VTE rate was highly dependent on extent of resection (1-2 segments, 1.7 %; 3-4 segments, 5.4 %; >4 segments, 6.7 %).

CONCLUSION: Major resection and increased EBL are associated with higher risk of VTE. These patients may warrant more intensive prophylax compared to those having minor resections with minimal blood loss.