Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin

Pariser, Joseph J.; Pearce, Shane M.; Anderson, Blake; Packiam, Vignesh T.; Prachand, Vivek N.; Smith, Norm D.; Steinberg, Gary D.

doi:10.1016/j.juro.2016.08.090

Cited by 51 publications

(47 citation statements)

References 25 publications

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“…It is well established that the VTE risk after RC is lower for patients on ETP compared to STP, and studies directly comparing VTE risk in ETP vs STP all showed this ( n = 3) . Although the follow‐up periods and definition of ETP varied, a lower VTE incidence was reported for patients on ETP, with VTE risk reported as 5.06% compared to 17.6% (90‐day follow‐up) , 2% compared to 6% (90‐day follow‐up) , and 11% compared to 23% (365‐day follow‐up) . Kukreja et al.…”

Section: Resultsmentioning

confidence: 96%

The role of extended venous thromboembolism prophylaxis for major urological cancer operations

et al. 2019

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Rishi Naik and Indrajeet Mandal are joint first authors. ObjectivesVenous thromboembolism (VTE), consisting of both pulmonary embolism (PE) and deep vein thromboses (DVT), remains a well-recognised complication of major urological cancer surgery. Several international guidelines recommend extended thromboprophylaxis (ETP) with LMWH, whereby the period of delivery is extended to the post-discharge period, where the majority of VTE occurs. In this literature review we investigate whether ETP should be indicated for all patients undergoing major urological cancer surgery, as well procedure specific data that may influence a clinician's decision. MethodsWe performed a search of six databases (PubMed, Cochrane, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and British Nursing Index (BNI)) from inception to June 2019, for studies looking at adult patients who received VTE prophylaxis after surgery for a major urological malignancy. ResultsEighteen studies were analysed. VTE risk is highest in open and robotic Radical Cystectomy (RC) (2.6-11.6%) and ETP demonstrates a significant reduction in risk of VTE, but not a significant difference in Pulmonary Embolism (PE) or mortality. Risk of VTE in open Radical Prostatectomy (RP) (0.8-15.7%) is comparable to RC, but robotic RP (0.2-0.9%), open partial/radical nephrectomy (1.0-4.4%) and robotic partial/radical nephrectomy (0.7-3.9%) were lower risk. It has not been shown that ETP reduces VTE risk specifically for RP or nephrectomy. ConclusionThe decision to use ETP is a fine balance between variables such as VTE incidence, bleeding risk and perioperative morbidity/mortality. This balance should be assessed for each specific procedure type. While ETP still remains of net benefit for open RP as well as open and robotic RC, the balance is closer for minimally invasive RP as well as radical and partial nephrectomy. Due to a lack of procedure specific evidence for the use of ETP, adherence with national guidelines remains poor. Therefore, we advocate further studies directly comparing ETP vs standard prophylaxis, for specific procedure types, in order to allow clinicians to make a more informed decision in future.

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Section: Resultsmentioning

confidence: 96%

The role of extended venous thromboembolism prophylaxis for major urological cancer operations

et al. 2019

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“…The VTE rate before and after the regimen implementation was 28/234 (12%) and 9/168 (5%) ( p = 0.024). Post-discharge VTE rates within 90 days of RC decreased from 6% to 2% ( p = 0.039) and transfusion rates were similar across both time periods 44% vs 49% ( p = 0.342) [15]. …”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Brennan

Karim

d’Oiron

et al. 2018

BLC

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Background:Chemotherapy and major pelvic surgery are established risk factors for venous thromboembolism (VTE). We evaluate the incidence rate, timing, and factors associated with VTE in patients with bladder cancer who underwent radical cystectomy and peri-operative chemotherapy in routine clinical practice.Methods:Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994–2013. VTE events within 6 months of before or after cystectomy were identified using diagnostic codes recorded on hospital admissions and emergency department visits. Multivariable logistic regression was used to analyze factors associated with VTE prior to surgery, within 90-days of cystectomy, and 120-days after the start of adjuvant chemotherapy.Results:4205 patients had cystectomy and 26% (1084/4205) received peri-operative chemotherapy. The overall incidence rate of VTE within 6 months of cystectomy was 9% (363/4205). VTE rate was highest among those patients treated with neoadjuvant chemotherapy (NACT) compared to patients treated with no chemotherapy or only adjuvant chemotherapy (ACT) (12% vs 8% vs 9%, p = 0.002). Among all VTE events, 10%, 28%, and 61% occurred before, during, and after hospitalization for cystectomy. Pre-operative VTE rate was highest among cases treated with NACT (4%) compared to patients with no chemotherapy (<1%) or ACT (<1%) (p < 0.001). VTE within 90 days of surgery was associated with greater length of hospital admission (p < 0.001) across all treatment groups.Conclusions:A substantial proportion of patients treated with peri-operative chemotherapy will develop VTE. The majority of these occur after discharge from hospital following cystectomy. Extended thromboprophylaxis treatment in high-risk patients including those who receive peri-operative chemotherapy should be considered.

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“…A retrospective review of more than 2300 patients undergoing radical cystectomy at our own institution found VTE incidence of 4.7% overall demonstrating the prevalence of this complication with the majority of these cases (57.8%) developing after discharge home at a median of 20 days postoperatively suggesting the role of extended VTE prophylaxis . Pariser et al found a decrease in overall VTE from 12% to 5% following initiation of extended duration enoxaparin to 28 days post‐operatively in a single‐center study. Extended VTE prophylaxis should be used for all patients undergoing radical cystectomy if possible.…”

Section: Radical Cystectomymentioning

confidence: 98%

Enhanced recovery after urologic surgery—Current applications and future directions

Zainfeld

Djaladat

2017

Journal of Surgical Oncology

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Coordinated multidisciplinary perioperative care through enhanced recovery protocols has improved outcomes within urologic surgery. Continued development and refinement of enhanced recovery after surgery (ERAS) pathways will further augment the care of patients undergoing all urologic procedures. Among the challenges, moving forward is identification of barriers to ERAS adoption by providers, maximizing adherence among patients, standardization of ERAS pathways through establishment of evidence-based principles, and application in additional complex urologic procedures beyond radical cystectomy.

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Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin

Abstract: Thromboprophylaxis with extended duration enoxaparin decreased the rate of venous thromboembolism after radical cystectomy compared to inpatient only subcutaneous heparin with no increased risk of bleeding.

Cited by 51 publications

References 25 publications

The role of extended venous thromboembolism prophylaxis for major urological cancer operations

The role of extended venous thromboembolism prophylaxis for major urological cancer operations

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Enhanced recovery after urologic surgery—Current applications and future directions

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