Anticoagulation After Pancreatic Resection: Does It Prevent Portal Vein Thrombosis?

Labib et al. (2025) conducted a large international multicentre cohort study (n=972) evaluating portal vein thrombosis (PVT) risk and anticoagulation practice after pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR) . Compared with matched controls without VR, PVT risk was significantly higher after VR— 5.1%, 7.3%, and 11.6% at 30, 90, and 365 days versus 1.0%, 1.3%, and 2.6% respectively (P<0.001).

Predictors of PVT included prior venous thromboembolism, VR type, and graft material, while cancer recurrence strongly predicted late (>90-day) PVT . Early postoperative anticoagulation reduced 30-day PVT risk (OR 0.06), but showed no sustained benefit beyond 90 days , leaving long-term efficacy uncertain. This study highlights the need for standardized anticoagulation protocols following PD/TP with VR and suggests technical versus oncological factors drive…