Elevated Risk of Complications in Patients Receiving Dual Antithrombotic Therapy Undergoing Hepatectomy: A Single-Center Audit of 749 Cases.

Aim: Increase in surgical patients undergoing antithrombotic therapy (ATT) has intensified the concerns regarding perioperative bleeding and thromboembolic complications. This study evaluated the safety of hepatectomy in patients receiving ATT, with a focus on those receiving dual therapy. Methods: We retrospectively analyzed 749 patients who underwent elective hepatectomies between 2011 and 2024. Among them, 140 received ATT according to the Japanese guidelines, and 98 were matched 1:1 with non-ATT controls using propensity scores. The primary outcome was major morbidity, defined as Clavien-Dindo ≥grade III; intraoperative blood loss and transfusion requirement were secondary outcomes. Outcomes were also compared across the ATT regimens, including dual therapy (antiplatelet plus anticoagulants). Results: Compared with the non-ATT group, the ATT group had a significantly longer operative time (median, 318 vs. 250 min; Conclusion: Hepatectomies can be safely performed in patients receiving well-managed ATT. However, dual therapy was associated with higher rates of perioperative complications, including bleeding and PHLF, compared with monotherapy or no ATT, underscoring the need for heightened caution and individualized management in this high-risk group.